Revue médicale de Liège
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Revue médicale de Liège · Jan 2014
[The value of electroencephalography monitoring and analysis during anesthesia].
Electroencephalography (EEG) records brain electrical activity at the scalp level. As a functional and non invasive witness of brain activity, EEG has long raised the interest of researchers and practitioners, notably in the domain of anesthesia. Thanks to technical advances, this complex signal can now be dissected, and a huge amount of information can be extracted from it. This information gives the opportunity to quantify theeffects of general anesthesia on the brain, and provides a better understanding of the underlying mechanisms.
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Agitation in psychiatry is defined as "a request to which an answer cannot be deferred". If some types of controllable agitation can be solved by human means or psychotropic drugs, others may require the intervention of intensivists who will contribute to the onset of crisis resolution. In addition, an organic aetiology must be carefully excluded a before considering a psychiatric origin of agitation, especially in patients with no psychiatric history and in the elderly. Indeed, acute agitation can hide serious somatic traps and be life threatening.
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The 2013 guidelines for arterial hypertension have just been released by the European Societies of Cardiology and Hypertension. As already discussed in earlier versions, the decision to treat must be based on the assessment of the cardiovascular risk. ⋯ A novelty, however, consists in the simplification of the blood pressure target under treatment, which must be < 140/90 mmHg in the vast majority of patients, except for octogenerians whose systolic blood pressure target should be < 150 mmHg. For resistant hypertension, renal denervation and carotid baroreceptor stimulation are proposed as new invasive modes of therapy; their clinical values, however, remain to be confirmed.
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Revue médicale de Liège · Oct 2013
Randomized Controlled Trial Multicenter Study Comparative Study[Hokusai-VTE: edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism].
Currently venous thromboembolic disease (VTE), i.e. deep venous thrombosis and pulmonary embolism, remains a major cause of morbidity and mortality all around the world. The Hokusai-VTE study is a randomized, double-blind trial to evaluate whether initial heparin (5 days) followed by the oral Xa factor inhibitor edoxaban (60 mg once daily) may be an alternative to the standard therapy, i.e. heparin (5 days) followed by warfarin (INR of 2.0-3.0) for the prevention of recurrent thromboembolism in patients with acute symptomatic VTE. In patients with VTE, including pulmonary embolism with right ventricular dysfunction, treatment with heparin followed by oral edoxaban 60 mg once daily was non inferior to the standard treatment with respect to efficacy and superior with respect to bleeding (fewer fatal and intracranial bleeds, but no statistical significance regarding major bleeding). Reducing the dosage of edoxaban to 30 mg once daily is safe in case of renal impairment and low body weight.
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Sexual addiction or sexual dependence is characterized by hypersexuality, impaired regulation of sexual desire and sexual compulsivity, including having sex with uncontrolled excessive frequency (5 to 15 sexual acts per day for more than 6 months, from 15 years old). Between 3% and 6% of the adult population (> or =18 years) would have the characteristics of sexual addiction, disorder prevalent in the male population. The addictive processes affect three behavioral domains : motivation-reward, affect regulation and behavioral inhibition. ⋯ Psychiatric comorbidities can be found : anxiety disorders, mood disorders. Several forms of treatment have been tried, using medication, cognitive-behavioral therapy and psychotherapy sessions alternated with exposure therapy in virtual reality. In this article, we will discuss the multiple definitions of hypersexuality and the possibilities of therapeutic approaches.