Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Oct 2011
Case Reports[Acute valproic acid intoxication: interest of a treatment by extracoporeal elimination combined with L-carnitine].
We present the case of a 24-year-old-female patient, who made an attempt to autolysis with valproic acid, benzodiazepines and neuroleptic. The valproic acid plasma level was very high (1437 μg/mL), confirming it was a severe intoxication. ⋯ The evolution was favourable despite the occurrence of a nosocomial ventilation acute lung injury. The patient had motor sequelae of cranial nerves following status epilepticus extended, which disappeared spontaneously after several days.
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Ann Fr Anesth Reanim · Oct 2011
Review[Post-surgery cognitive disorders: prevention, diagnosis and treatment strategies].
Hip fracture is an important step in the autonomy evolution in elderly. As gait is particularly jeopardised after such a traumatism, cognition may also be acutely impaired. Elderly post-surgery delirium is frequent, but chronic progression of cognitive impairment and dementia may occur. ⋯ A neurodegenerative disease such as Alzheimer's disease may be clinically silent prior the traumatic event, and may decompensate soon after as the cognitive reserve is not sufficient anymore. Dementia may then lead to progressive autonomy loss. A systematic interdisciplinary approach is needed to prevent frail patients from delirium, and to early cure it to decrease the risk of long-term autonomy loss.
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Hip fracture is a major health burden due to both its frequency and its deep impact on patient's outcome. The key issue of this poor outcome seems to be cardiac complications. The onset of these cardiac complications seems to appear early in the clinical course in the form of perioperative myocardial ischemia that are both preventable and treatable. Their clinical and electrocardiographic pattern is very poor and they can be thoroughly detected by only either a systematic electrocardiographic 12 lead monitoring or troponin dosage.