Presse Med
-
Recent studies have confirmed that the mean blood pressure levels recorded during ambulatory monitoring are lower than the levels measured by the standard cuff method, possibly due to the "white coat" effect which involves as many as 25 to 30% of the total hypertensive population. In addition, ambulatory blood pressure monitoring is particularly useful to evaluate the day/night cycle. Loss of the normal decrease in blood pressure at night occurs in certain types of secondary hypertension and can be revealed by ambulatory monitoring. ⋯ Ambulatory monitoring can also modify management decisions as found in a recent survey conducted in the United States demonstrating the impact on the treatment of hypertension. For 30 to 40% of the hypertensive patients, therapeutic management was different after ambulatory monitoring than after conventional cuff measurement. Standardization will be the next step in the widespread use of ambulatory blood pressure monitoring.
-
Clinical assessment is an essential fundamental element in the evaluation of comatose states, particularly in children. Paediatricians quickly recognized that the early Glasgow Coma Scale, used for over 20 years in adults, is inadapted for children because it lacks brain stem criteria, involves interpretation of motor response (particularly difficult in infants) and uses verbal response which is of little value before language acquisition. The first attempt at standardized coma assessment in children was the Paediatric Coma Scale, developed in Australia in 1982. ⋯ Several comparative studies have been conducted to determine the positive predictive value and interpersonal variability of these scales. In a prospective multicentric study of 277 comatose children aged 6 months to 15 years, we found that the Bicêtre scale had a positive predictive value of 94% for good outcome at 24 hours and that interpersonal disagreement occurred in only 10.1% of 65 cases studied (compared with 13.5% for the Glasgow scale which was studied simultaneously). Paediatricians now have reliable clinical scales for assessing the conscious level in children.
-
Editorial Review
[Non steroidal anti-inflammatory agents marketed as analgesics].