L'union medicale du Canada最新文献

Significant changes have occurred in aerosol therapy in the last few years. New devices have been developed to facilitate the administration of bronchodilator or anti-inflammatory drugs into the airways. Metered-dose inhaler with or without a spacer or powder devices are now considered the ideal mode of administration of aerosolized medications in the regular treatment of child or adult asthma as well as in COPD. In mild to moderate acute asthma, bronchodilators are ideally administered with a metered dose inhaler with a spacer device, nebulisation being required in only a minority of patients. Powder devices such as the Turbuhaler may also be useful in acute asthma but inspiratory flow should be sufficient, and their usefulness in this context remains to be better determined. In severe acute asthma or in patients unable to properly use the other inhalation devices, nebulisation can be used, with oxygen in the case of acute asthma. In patients requiring mechanical ventilation, administration of bronchodilators can be done with a metered-dose inhaler with a spacer device specifically designed for this purpose: it will replace nebulisation in most cases. In young children and infants unable to use spacer devices with a mouthpiece (< 5 years), wet nebulisation is still used during acute attacks of asthma. In these circumstances, the use of metered-dose inhalers with a spacer and mask are probably appropriate in some children but further studies are required to recommend their use.

Acromegaly is a rare disease which can significantly reduce life expectancy. Clinical features are diverse and the patient may consult a variety of medical and surgical specialists before the diagnosis is suspected. However, the disease is easily confirmed by the appropriate laboratory tests, namely GH and IGF1 measurements. In most cases, acromegaly is secondary to a micro or macrosomatotrope pituitary adenoma. Those lesions are easily visualized by a pituitary CT Scan or Magnetic Resonance Imaging. Visual fields have to be evaluated by a neuro-ophthalmologist, and a thorough evaluation of other pituitary functions have to be performed. Selective removal of the adenoma by the transsphenoidal route is the treatment of choice for acromegaly. When performed by an experienced neurosurgeon, normalization of GH secretion can be expected in approximately 75% of cases. The surgical outcome is modulated by the volume, the extension of the tumor and the preoperative GH level. Octreotide, radiotherapy or bromocriptine are indicated whenever the patient remains with an elevated level of GH with persistency of symptoms.

The department of psychiatry of the Université de Montréal has now organized a well structured research network in the area of child, adult and forensic psychiatry. The authors summarize the scientific approach according to research in these different sectors and believe that, although research in psychiatry now tends to promote diagnostic and treatment methods based more and more on neuro-sciences, it does not neglect the contribution of psychosocial and clinical aspects without which the human dimensions of mental illness and the objective of improvement of care to patients would be rapidly forgotten on behalf of disembodied research projects completely deprived of the relation with patients.

The mortality associated with coronary atherosclerosis has decreased by 30% to 40% in the last few decades. This reduction has followed major pharmacological and biotechnological advances and can possibly be attributed to better management of risk factors for coronary atherosclerosis and to more effective therapy of its late manifestations. Nevertheless, the coronary artery disease remains a major public health problem. It is responsible for 40% to 45% of deaths in our population and, although it becomes manifest later than previously, its incidence and prevalence may not have declined significantly. Recent studies suggest that progression of coronary atherosclerosis can be delayed, that regression can also occur, and that this can lead to a reduction in morbidity and mortality. Several types of interventions have been performed in these studies. Some of them such as a drastic modification in lifestyle, the administration of one or several hypocholesterolemic agents or partial ileal bypass have achieved these results by markedly lowering LDL or raising HDL cholesterol. Other manipulations of plasma lipoproteins are also possible, such as the administration of specific protein or enzyme inhibitors, anti-oxidants and omega-3 fatty acids. Calcium antagonists and possibly angiotensin converting-enzyme inhibitors slow the progression of early coronary lesions and prevent the appearance of new lesions. These interventions, in addition to influencing the size of the atherosclerotic plaque, can have other important effects. They can contribute to the preservation of integrity and function of endothelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Kidney transplantation is a well recognized form of treatment for end-stage renal failure patients. Transplanted patients can hope for a prolonged and productive life. Many factors are responsible for the improvement of kidney transplantation over the last years. Despite its progress and success, many limitations still exist: shortage of kidney, humoral hypersensitivity or recipients, side effects of immunosuppressive medication and chronic rejection. Will the induction of specific tolerance to xenograft, with the help of transgenic biology, be the solution of tomorrow?

Chemoprevention, or pharmacological intervention in healthy individuals at risk of developing cancer, is attracting attention as a potential tool in cancer prevention. Lung cancer, with its high incidence and poor prognosis, is a particularly interesting disease for these studies. The retinoids are a promising group of chemopreventive agents, since they are involved in growth control and are a necessary cofactor for proper activity of a protein receptor which we have shown to be a lung cancer suppressor. Nevertheless, the toxic side effects of retinoids at pharmacological dose present difficulties and current studies are aimed at determining the efficacy of various forms of retinoids and chemoprevention protocols in the target populations.