Presse Med
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Review
[Nitric oxide (NO), vascular protection factor. Biology, physiological role and biochemistry of NO].
VASOMOTRICITY: The vascular endothelium plays a key role in vasomotricity by producing a number of factors which modulate smooth muscle relaxation and contraction. Nitric oxide (NO) has been found to be one of the most important relaxation factors. NO SYNTHESIS: Nitric oxide is synthesized from L-arginine by NO-synthetase whose activity is regulated by intracellular calcium concentration and modulated by pharmacological compounds such as acetylcholine, 5-hydroxytryptamine, bradykinin and ADP as well as the sheer forces produced by blood flow.
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INDICATIONS FOR DRUG THROMBOLYSIS: There has been much debate on the indications for drug thrombolysis in pulmonary embolism. Thrombolysis would not appear to be justified excepting in massive pulmonary embolism when clinical signs or explorations evidence poor hemodynamic tolerance. Current data would confirm its independent effect on reducing mortality in such cases. ⋯ THE PREPIC STUDY: The first controlled prospective trial on caval filters confirmed that indications for caval interruption in patients with proximal deep vein thrombosis should be limited to contraindications and failures of anticoagulant therapy. Other indications for filters, whether temporary or definitive, should be evaluated with specific controlled prospective trials. LOW-MOLECULAR WEIGHT HEPARINS: If this possibility is confirmed for the treatment of pulmonary embolism, it will provide a simple rational treatment for venous thromboembolism. 'SMALL CLOTS': Changing diagnostic strategies, particularly the use of helical CT angiography, has raised the question of therapeutic abstention when "small" clots are undetectable by this exploration.
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DEFINITION AND FREQUENCY: An ileoanal anastomosis with creation of an ideal pouch is proposed as the treatment for familial adenomatous polyposis and ulcerative hemorrhagic rectocolitis. The ideal pouch may become inflammatory in 10 to 30% of the cases. The diagnosis of pouchitis is based on a clinical, endoscopid and histological criteria.
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Review
[Pneumococci with diminished sensitivity to penicillin in pneumopathies. Clinical consequences].
INCREASING PREVALENCE: Since 1988, French clinicians have been faced with an increasing prevalence of penicillin-resistant pneumococcal pneumonia. In 1996, the percentage of strains with reduced susceptibility to penicillin reached more than 40% and the number of multiresistant strains has increased steadily.