ABSTRACT
A manual medicine consultation has existed in the canton of Vaud for ten years now, developed within Unisanté, the university centre for general medicine and public health in Lausanne. For a long time, this consultation was the only one of its kind set up in a university setting in Switzerland. Despite a growing interest and a more important development in German-speaking Switzerland and Germany, this approach remains relatively unknown to patients and therapists in the French-speaking cantons. This birthday is an opportunity to put the spotlight on what manual medicine is, to retrace the history of the establishment of the consultation in the canton and to illustrate its practice through a clinical vignette.
Voilà maintenant 10 ans qu'une consultation de médecine manuelle existe dans le canton de Vaud, développée au sein d'Unisanté, le centre universitaire de médecine générale et de santé publique à Lausanne. Cette consultation a longtemps été la seule de cette discipline mise en place en milieu universitaire en Suisse. Malgré un engouement croissant et un développement plus important en Suisse alémanique et en Allemagne, cette approche reste cependant relativement peu connue des patients et des thérapeutes des cantons romands. Cet anniversaire est l'occasion de donner un coup de projecteur sur ce qu'est la médecine manuelle, de retracer l'historique de la mise en place de la consultation dans le canton et d'en illustrer la pratique par une vignette clinique.
Subject(s)
Public Health , Humans , Retrospective Studies , Switzerland , GermanyABSTRACT
Tension-type headaches (TTH) are a very common condition. The most recent theories on TTH occurrences suggest that a myofascial component, through trigger points (TP), gives rise to pain signals from the periphery to the central nervous system (CNS). These nociception could lead to CNS sensitization and headaches. Studies show that identification and treatment of TP is a valid therapeutic option for TTH. Amongst the treatment techniques, dry needling (DN) and ischemic compression (IC) seem to be the most effective. These technics can be easily acquired and applied by any doctor.
Les céphalées de tension (CT) sont très fréquentes dans notre société. Les théories les plus récentes sur la génération des CT suggèrent que la composante myofasciale, via les points gâchette, ou trigger points (TP), soit à l'origine de signaux nociceptifs de la périphérie vers le système nerveux central (SNC). Cette nociception pourrait provoquer une sensibilisation du SNC et des céphalées. Les études montrent que pour les CT, l'identification et le traitement des TP sont des options thérapeutiques valables. Parmi les techniques de traitement, le dry needling (DN) et la compression ischémique (CI) semblent être les plus efficaces. Ces techniques peuvent être acquises rapidement et appliquées par tout médecin.
Subject(s)
Pain Management/methods , Tension-Type Headache/therapy , Humans , Pain/physiopathology , Tension-Type Headache/physiopathology , Trigger PointsABSTRACT
Scrotal pain is frequently encountered in practice, as it affects 4 men in 1000, with a peak of incidence between the ages of 45 and 50. After excluding an urological or gastrointestinal cause, referred pain of musculoskeletal origin should be considered, even in the absence of back pain. Described by Dr. Robert Maigne, this referred pain originates from a minor intervertebral dysfunction of the thoracolumbar junction. Imaging of the spine is not helpful. Rather, the diagnosis is made by seeking pain triggered by the mobilization of the lumbar vertebrae; the pinch and roll skin manoeuvre will highlight this referred pain. Treatment is symptomatic, though manual therapies by spine specialists are also recommended.
Subject(s)
Pain/etiology , Testicular Diseases/diagnosis , Adult , Diagnosis, Differential , Humans , Incidence , Male , Middle Aged , Testicular Diseases/epidemiology , Testicular Diseases/etiologyABSTRACT
BACKGROUND: We evaluated the Ziehl-Neelsen staining (ZNS) technique for the diagnosis of paragonimiasis in Laos and compared different modifications of the ZNS techniques. METHODOLOGY: WE APPLIED THE FOLLOWING APPROACH: We (1) examined a paragonimiasis index case's sputum with wet film direct examination (WF) and ZNS; (2) re-examined stored ZNS slides from two provinces; (3) compared prospectively WF, ZNS, and formalin-ether concentration technique (FECT) for sputum examination of patients with chronic cough; and (4) compared different ZNS procedures. Finally, we assessed excess direct costs associated with the use of different diagnostic techniques. PRINCIPAL FINDINGS: Paragonimus eggs were clearly visible in WF and ZNS sputum samples of the index case. They appeared brownish-reddish in ZNS and were detected in 6 of 263 archived ZNS slides corresponding to 5 patients. One hundred sputum samples from 43 patients were examined with three techniques, which revealed that 6 patients had paragonimiasis (13 positive samples). Sensitivity per slide of the FECT, ZNS and the WF technique was 84.6 (p = 0.48), 76.9 (p = 0.25) and 61.5% (p = 0.07), respectively. Percentage of fragmented eggs was below 19% and did not differ between techniques (p = 0.13). Additional operational costs per slide were 0 (ZNS), 0.10 US$ (WF), and 0.79 US$ (FECT). ZNS heated for five minutes contained less eggs than briefly heated slides (29 eggs per slide [eps] vs. 42 eps, p = 0.01). Bloodstained sputum portions contained more eggs than unstained parts (3.3 eps vs. 0.7 eps, p = 0.016). CONCLUSIONS/SIGNIFICANCE: Paragonimus eggs can easily be detected in today's widely used ZNS of sputum slides. The ZNS technique appears superior to the standard WF sputum examination for paragonimiasis and eliminates the risk of tuberculosis transmission. Our findings suggest that ZNS sputum slides should also be examined routinely for Paragonimus eggs. ZNS technique has potential in epidemiological research on paragonimiasis.
