Revue médicale de Liège
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We present a case of Capnocytophaga canimorsus fulminant infection linked to a dog bite in a splenectomized patient. Capnocytophaga canimorsus is a gram-negative rod that typically causes septicaemia with disseminated intravascular coagulation in both immunocompromised and immunocompetent hosts. It is associated with high mortality. We also reviewed the literature and provide some recommendations on the management of bite wound as well as on both prevention and treatment of infection in asplenic state.
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Revue médicale de Liège · Jan 2002
[Clinical study of the month. Effects of valsartan in chronic heart failure: the VAL-HeFT study].
Current guidelines recommend drugs which reduce neurohormonal activation as standard therapy for heart failure: angiotensin converting-enzyme (ACE) inhibitors, beta-blockers and spironolactone. The Valsartan Heart Failure Trial (Val-HeFT) tested the efficacy of the angiotensin-receptor blocker valsartan in addition to prescribed therapy. ⋯ Valsartan had highly favourable effects in patients not receiving ACE inhibitors but an adverse effect in patients receiving both ACE inhibitors and beta-blockers. The effects of adding valsartan are depending on the importance of previous neurohormonal inhibition.
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Revue médicale de Liège · Dec 2001
Randomized Controlled Trial Clinical Trial[Clinical study of the month. Toxicity of hyperglycemia in intensive care and beneficial effects of optimized insulin therapy].
A large Belgian, prospective, controlled study was performed in 1.548 critically ill patients (83% without history of diabetes) hospitalised in a surgical intensive care unit. On admission, patients were randomly assigned to receive intensive intravenous insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg/dl) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg/dl and maintenance of glucose at a level between 180 and 200 mg/dl). Intensive insulin therapy reduced morbidity and mortality by 40%. These remarkable results should influence further therapeutical attitudes in intensive care units and open new perspectives for the management of critically ill patients.
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Revue médicale de Liège · Jun 2001
[Euthanasia and other medical decisions concerning the end of life in Belgium: epidemiologic studies].
The study presented here is the first replica of the Dutch death certificate study on end of life decisions (ELDs). The main objective was to assess the incidence of euthanasia (the administration of drugs with the explicit intention to shorten the patient's life at the explicit request of the patient), physician assisted suicide (PAS), and other ELDs in medical practice in Belgium (Flanders). ⋯ ELDs are prominent in medical practice in Belgium (Flanders). The incidence of deaths preceded by an ELD is similar to the Netherlands, but greater than in Australia. However, in Belgium (Flanders) the incidence of ending of patient's life without the patient's explicit request (3.2%, 2.7-3.8% CI: 95) is similar to Australia (3.5%, 2.7-4.3% CI: 95), but significantly higher than in the Netherlands (0.7%, 0.5-0.9% CI: 95).
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Pneumomediastinum in children is diagnosed in two circumstances: cervical subcutaneous emphysema or radiological findings. The predominant symptoms are dyspnoea, stabbing chest pain, sore throat and dysphagia. Traumatic injuries and pulmonary diseases such as asthma are the most common causes of pneumomediastinum. ⋯ The treatment is directed towards the underlying cause, with conservative management being sufficient in most cases. However, the risk of surveying of pneumothorax or tension pneumomediastinum justifies close clinical follow-up in a specialised care unit. The onset of these pathologies necessitates a more aggressive therapy by aspiration through percutaneous catheter placed in the mediastinum.