Revue médicale de Liège
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Most patients who remain comatose for a few hours after a period of global cerebral ischemia have a poor prognosis. Early identification of these patients is desirable to reduce uncertainty about treatment and non-treatment decisions, and to improve relationships with the family. The absence of pupillary light response and corneal reflexes, absent or stereotyped extension motor response to noxious stimulation (3 days after insult); myoclonus status epilepticus; absence of cortical N20 response on somatosensory evoked potential studies; generalised suppression or burst-suppression EEG and serum neuron-specific enolase above 33 microg/L (sampled 1-3 days after insult) have been shown to predict poor outcome. We here propose an algorithm to help intensive care physicians' clinical decision making in post-anoxic coma.
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Revue médicale de Liège · Apr 2008
[How I treat... by optimizing the blockade of the renin-angiotensin-aldosterone system].
The blockade of the renin-angiotensin-aldosterone system (RAAS) has been shown to be useful, or even mandatory, in the management of arterial hypertension, congestive heart failure, post-myocardial infarction and nephropathy with albuminuria, due to diabetes or not. Such blockade can be obtained with an angiotensin converting enzyme inhibitor, a specific antagonist of angiotensin II AT1 receptors and/or recently a direct inhibitor of renin such as aliskiren. ⋯ The present article describes the various modalities to optimize the RAAS blockade, either by using a maximal dosage of a monotherapy, or by choosing a double inhibition of RAAS. New prospects for the RAAS blockade will be also briefly considered.
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Revue médicale de Liège · Dec 2007
Case Reports[Clinical case of the month. Atrial flutter with rapid ventricular response (1:1 atrioventricular conduction) caused by flecaïnide].
We report a case of 1:1 flutter in a patient taking flecaïnide for atrial fibrillation. We discuss the mechanism of the arrhythmia, its treatment and the preventive attitude to be adopted.
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We discuss the case of a 49 year old man who was admitted to the emergency department with acute heart failure. He suffered from severe alcoholism and malnutrition. ⋯ The treatment consisted of intravenous administration of thiamine. The clinical response was spectacular with normalization of cardiac function within a few hours.