Presse Med
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Acute dissection of the aorta is a rare disease which, when left untreated, has a disastrous prognosis. Two aetiological factors are essential: acquired or congenital fragility of the aortic elastic tissue, and arterial hypertension. The condition must be diagnosed as early as possible to avoid a fatal outcome: it is a surgical emergency. ⋯ Acute dissection of the ascending aorta is treated by surgery: the ascending segment is resected, the distal cylindres are recoupled to close the portal of entry, and the aortic regurgitation is treated by valvuloplasty or aortic valve replacement. The introduction of the GRF biological glue has considerably improved the per-operative prognosis and lowered the hospital mortality to 10%. Long-term post-operative follow-up of the patient is crucial, since iterative dissection and formation of aneurysms are not exceptional, especially in patients with Marfan's syndrome.
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Home blood glucose monitoring (HBGM) may be useful to achieve better metabolic control in type I diabetes. The aim of this study was to evaluate longterm results in a large population. A questionnaire was given to 282 routinely insulin-treated diabetics regularly attending our clinic. ⋯ The influence of HBGM on metabolic control as currently performed by diabetic patients in everyday life may be overemphasized. These disappointing results are mainly due to the fact that patients carry out passive home glucose testing and not home blood glucose monitoring which implies day-to-day adaptation of insulin dosage. Such an attitude seems to be due to incorrect selection of the patients, insufficient education and care and, for some patients, poor compliance with medical advice.
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The choice and timing of therapeutic methods for injuries of the lower limbs were evaluated in 60 patients. Primary amputation had to be performed in 18 of them, and conservative treatment was attempted in the others. Sixteen secondary amputations were necessary, mostly for arterial lesions. ⋯ When local signs of complication were present, this difference was highly significant. Age over 50 and arterial lesions were aggravating factors. When present together with an already high severity score, these factors should suggest immediate amputation as a life-saving measure.