Stratégies diagnostiques des diarrhées chroniques de l'adulte [Chronic diarrhea in adults: diagnostic strategies]

The presence of chronic diarrhea requires a prompt diagnostic strategy in order to avoid risks of malnutrition and electrolytic disturbances. Two different clinical situations, i.e. collagen colitis and secretory diarrhea, exemplify the diagnostic evaluation of a single symptom. This non exhaustive review should lead to a diagnostic strategy of chronic diarrhea.

Etat confusionnel avec pneumencéphale: quel est votre diagnostic [A patient with confusion and pneumocephalus: what is your diagnosis?]

We report the case of a 58 year old male who presented with acute meningoencephalitis and pneumocephalus (intracranial air) visualized on head CT scan. Despite the lack of typical clinical signs such as retroauricular tenderness, red tympanic membrane or otorrhea, mastoiditis was suggested by head CT scan. The patient made a full recovery after mastoidectomy and six weeks of antibiotic therapy. Streptococcus pneumoniae grew from a surgical purulent mastoid tissue sample. Mastoiditis and its complications are rare in adults. A high level of clinical suspicion is needed when a patient presents with encephalitis of unclear origin.

Die Krankheit Depression kann jeden treffen [In Process Citation].

The survey "Datenerhebung zur Depression in der Allgemeinbevölkerung" was conducted from fall 2010 to spring 2011 on several online platforms. The results show that there is a considerable timespan between the appearance of initial symptoms of depression and the first diagnosis of a patient. Intervention at early stages of the disease can reduce a potentially long time of suffering and can lead to the successful treatment of depression. General practitioners play an important role as the link between patient and psychiatrist.

Aplicaciones del láser en odontologia

Existen diferentes tipos de láseres que pueden tener aplicación en Odontología, y éstos pueden ser utilizados con diferentes fines. El propósito de este artículo es comentar, de forma genérica, el empleo de diferentes tipos de láseres en diversos tipos de tratamientos habituales en la práctica odontológica. No todos los láseres producen los mismos efectos; tampoco un mismo láser produce el mismo efecto sobre diferentes tejidos, y, según sean los parámetros de emisión utilizados, incluso el mismo láser puede producir diferentes efectos sobre el mismo tejido. Para poder incorporar el láser a la praxis diaria, el profesional debe conocer, entre otros extremos, las indicaciones, las contraindicaciones y la forma de utilización del tipo o tipos de láseres que desee utilizar, antes de su aplicación en clínica.

Insuffisance surrénalienne et hypercalcémie: association fortuite [Adrenal insufficiency and hypercalcemia--an unusual presentation]

A 49 y.o. man was admitted for investigation of an intense fatigue associated with nausea, vomiting, weight loss and headache. Examination and work-up reveals a moderate hypercalcaemia and a panhypopituitarism attributed to a craniopharyngioma. Extensive work-up has excluded the most frequent causes of hypercalcaemia and we finally attributed this anomaly to the adrenal failure. In this article, we discuss the diagnostic approach, the etiology and physiopathology of this hypercalcemia and his association with endocrinological anomalies such as adrenal failure.

Observando los conflictos en la institución educativa y establecimiento de buenas prácticas

El fenómeno y/o la cuestión del conflicto en el escenario educativo es un temacomplejo pero a la vez muy relevante, para las diferentes problemáticas sociales,que afectan a los sistemas educativos actualmente. Este puede ser abordado desdediversas perspectivas y se le añade la dificultad para su identificación, análisis yvaloración para su adecuada resolución y/o gestión a través de las buenas praxis, yasea a través de la mediación o de otras intervenciones de naturaleza similar. Elconflicto en la Institución Educativa (IE) es inherente a las relaciones sociales,mantiene una estrecha relación con la convivencia entre todos los agentes socialesde la comunidad educativa (docentes, alumnos, familias, etc.). Y, en función de lagestión del conflicto, se podrán observar consecuencias en la salud, concretamenteen el bienestar o malestar de los implicados. Galtung (2003), entre otros autores,apuesta por una perspectiva positiva del conflicto, donde éste se convierte en lafuerza y el motivo por el cambio personal y social. Lederach (2000) asume que elconflicto supone una interacción entre dos adversarios que compiten por susintereses pero que necesitan de la cooperación para alcanzar acuerdos, y sirve parael crecimiento personal. Vinyamata (2005) nos dice que el conflicto es el motor y laexpresión de las relaciones humanas. Por tanto, podemos decir que se trata de una"vivencia subjetiva o una experiencia de los implicados en las relaciones humanasen un entorno determinado". Desde una perspectiva positiva el conflicto, puedeconvertirse en un motivo o un estímulo para el bienestar y la promoción de la salud,generando cambios sociales y personales que se correspondan con las aspiracioneslegítimas, pero también puede ser una fuente de malestar y de obstáculos para eldesarrollo de la labor educadora y de las relaciones humanas y profesionalessaludables...

Analyse critique des résultats de biopsies musculaires et de la méthodologie utilisée dans 889 cas d'affections neuromusculaires [Critical analysis of the results of muscle biopsies and of the methods used in 889 cases of neuromuscular disorders]

The contribution of muscle biopsies to the diagnosis of neuromuscular disorders and the indications of various methods of examination are investigated by analysis of 889 biopsies from patients suffering from myopathic and/or neurogenic disorders. Histo-enzymatic studies performed on frozen material as well as immunohistochemistry and electron microscopy allowed to provide specific diagnoses in all the neurogenic disorders (polyneuropathies and motor neuron diseases), whereas one third of myopathies remained uncertain. Confrontation of neuropathological data with the clinical indications for histological investigations shows that muscle biopsies reveal the diagnosis in 25% of the cases (mainly in congenital and metabolic myopathies) and confirm and/or complete the clinical diagnosis in 50%. In the remaining cases with non specific abnormalities neuropathological investigations may help the clinician by excluding well defined neuromuscular disorders. Analysis of performed studies and results of investigations show the contribution and specificity of each method for the diagnosis. Statistical evaluation of this series indicates that cryostat sectioning for histo- and immunochemical and electron microscopy increases the rate of diagnoses of neuromuscular diseases: full investigation was necessary for the diagnosis in 30% of the cases. The interpretation of the wide range of pathological reactions in muscles requires a close cooperation with the clinician.

L'éthylglucuronide: un marquer de la consommation d'alcool [Ethyl glucuronide: a biomarker of alcohol consumption]

Excessive alcohol consumption represents a major risk factor for morbidity and mortality. It is therefore indispensable to be able to detect at-risk drinking. Ethyl glucuronide (EtG) is a specific marker of alcohol consumption. The determination of ethyl glucuronide in urine or blood can be used to prove recent driving under the influence of alcohol, even if ethanol is no longer detectable. The commercialization of an EtG specific immunological assay now allows to obtain preliminary results rapidly and easily with satisfying sensitivity. Moreover, the detection of ethyl glucuronide in hair offers the opportunity to evaluate an alcohol consumption over a long period. The EtG concentration in hair is in correlation with the amount of ingested alcohol. Thus, the analysis of ethyl glucuronide can be used to monitor abstinence, to detect alcohol relapse and to identify at-risk drinkers. However, a cut off allowing to detect chronic alcohol abuser reliably still does not exist. Therefore, it is recommended to perform the analysis of ethyl glucuronide in complement to the existing blood markers. A study financed by the Swiss Foundation for Alcohol Research is actually conducted by the West Switzerland University Center of Legal Medicine in order to establish an objective cut-off.

Faut-il traiter l'osteoporose liee a la thalassemie majeure: deux cas cliniques [Should we treat thalassemia-induced osteoporosis: two case reports].

We report two cases of beta-thalassemia-induced osteoporosis. A man and a woman presented an osteoporosis at the densitometry and were treated with bisphoshonate iv. All the studies analysed the efficacity of bisphosphonate, in particular zoledronate seems to be effective. Concerning the pathogenesis, the RANK-RANK-Ligand and OPG play a major role in bone-resorption and seem to be the principal implicated mechanism for the development of osteoporosis in BTM. At the moment there is no study evaluating the efficacity of denosumab in the BTM.

Pluralidad en la diferencia

En ocasión del fallecimiento de la filósofa y escritora Françoise Collin el 1 de septiembre de 2012, el consejo de redacción ha considerado oportuno reeditar el posfacio que Fina Birulés hizo al volumen de ensayos de Collin Praxis de la diferencia. Liberación y libertad (Icaria Editorial, "Mujeres y culturas", 2006).

Prévention du sida chez les toxicomanes en Suisse: une évolution encourageante. [Prevention of AIDS in drug addicts in Switzerland: an encouraging development].

Switzerland has adopted a prevention strategy including the promotion of non-sharing injection material and use of condoms. The access to sterile equipment has been made easier, but regional differences still exist. Studies conducted between 1989 and 1992 among drug users in different Swiss regions are reviewed in order to examine if progress in prevention occurred. Syringe sharing diminished everywhere, but rather high sharing rates persist where sterile material is less accessible. Condom use increased, but the situation is still unsatisfactory considering the high HIV prevalence among i.v. drug users. Where several surveys have been conducted consecutively, a stabilization of HIV prevalence was observed. This suggests a slowing down of the progression of the epidemic among drug users. These results, obtained in few years, are encouraging in the light of the pessimism which prevailed at the beginning of the epidemic about the ability of drug users to adopt preventive behaviour.

Centre orientador: acompanyar en el creixement de l’alumnat

La comunicació que presentem és el resultat del treball de recerca i reflexió realitzatpel Grup de Recerca en Acció Tutorial (GRAT) de l’ICE de la UB amb l’objectiu de definir el camíen la construcció dels centres orientadors. Pensem que un centre educatiu ha d'incorporar l'orientaciócom a eix vertebrador de la seva praxis docent. Tal i com apunten Giner i Puigardeu(2008) «La acción tutorial no puede ser una acción puntual, inconexa ni desordenada, sino todolo contrario, un engranaje participativo de los diferentes agentes educativos que participan dela educación de nuestros alumnos, donde su objetivo final es incidir en el alumno o alumna, en su crecimiento personal, en su encaje en la sociedad y en la construcción de la realidad que le envuelve».

Pluralidad en la diferencia

En ocasión del fallecimiento de la filósofa y escritora Françoise Collin el 1 de septiembre de 2012, el consejo de redacción ha considerado oportuno reeditar el posfacio que Fina Birulés hizo al volumen de ensayos de Collin Praxis de la diferencia. Liberación y libertad (Icaria Editorial, "Mujeres y culturas", 2006).