Revue médicale de Liège
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Revue médicale de Liège · Jan 2007
Review[Monitoring the depth of anaesthesia: why, how and at which cost?].
The precise titration of anaesthetic agents is necessary to avoid the consequences of a too light depth of anaesthesia such as unexpected intraoperative awareness, as well as a too deep level of anaesthesia, which can be deleterious in terms of postoperative morbidity and mortality. The clinical evaluation of the depth of anaesthesia is poorly sensitive and specific. It does not permit to distinguish between pharmacodynamic components of anaesthesia. ⋯ They are efficient at reducing the incidence of unexpected intraoperative awareness, adjusting anaesthetic depth at an individual scale, predicting the time needed for recovery, allowing early extubation of patients, reducing their length of stay in the post anaesthesia care unit, and limiting the number of episodes of peroperative over and under dosage of anaesthetic agents. The knowledge of conditions that may impede the accurate interpretation of those indices is mandatory for an optimal use. Although undoubtedly beneficial for the patients, the use of those monitors is frequently responsible for supplementary' costs, particularly when the procedure is short.
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Revue médicale de Liège · May 2006
Review Case Reports[Patent foramen ovale and migraine, a fortuitus association or a causal relationship?].
Epidemiologic studies have shown a clear comorbidity between migraine with aura and a patent foramen ovale (PFO). Under the age of 55, migraine with aura is a risk factor for ischemic stroke and a proportion of the latter is due to a PFO. It remains to be determined whether PFO is causally related to migraine attacks, or is a fortuitous association due to common genetic factors. ⋯ Several retrospective and uncontrolled studies suggest that percutaneous closure of a PFO for stroke or decompression illness in divers reduces frequency of migraine attacks with, but also without aura. Multicentric, prospective and controlled trials of this intervention in migraineurs are underway or in preparation. As long as their results are not known, there is no rationale for proposing PFO closure for migraine.
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Maturity-onset diabetes of the young (MODY) is a monogenic subtype of diabetes mellitus characterized by a young onset of type 2 diabetes, some abnormalities of the beta-cell function and an autosomal dominant inheritance with high penetrance. MODY types represent less than 5% of all cases of type 2 diabetes. ⋯ Among the two most frequent forms, MODY 2 (mutation of the glucokinase gene) has a benign clinical evolution whereas MODY 3 (mutation of HNF-1alpha gene) has a much more severe evolution. The recognition of the MODY diabetes is important in clinical practice and may lead to the discovery of new more specific molecular therapeutic targets.
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Revue médicale de Liège · May 2005
Review[Metabolic emergencies related to diabetes mellitus: ketoacidosis and hyperosmolar state].
Diabetic ketoacidosis and hyperglycaemic hyperosmolar state are relatively frequent metabolic emergencies. Such entities complicate type 1 and type 2 diabetes mellitus, respectively. ⋯ Prognosis of such complications remains generally severe. Management is based on insulin infusion, fluid resuscitation as well as concomitant compensation for electrolytes losses.
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Compartment syndrome is defined as an increased intracompartmental pressure within inelastic fascia which surround muscular compartments. That pathology can be either acute or chronic. The acute situation is generally a medical emergency. ⋯ If pressures reach the critical threshold (30 mm Hg) and remain high five minutes after exercise, compartment syndrome is present. Treatment is nearly exclusively surgical. It consists in an fasciotomy allowing a complete recovery and a return to sport activities.