Revue médicale suisse
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Revue médicale suisse · Jan 2015
[What is new in 2014 for the specialist in hospital internal medicine? The point of view of university hospital chief residents].
The year 2014 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice and on the way we manage one problem or another. From the use of the ultrasound for the diagnosis of pneumonia to the choice of the site of venous access and the type of line, and the increasing complexity of choosing an oral anticoagulant agent, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.
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Management of all pathologies, and in particular that of the most frequent ones, should whenever possible be based on robust evidence and arguments. New studies published this year enable rationalizing of screening in certain clinical situations, more adequate treatment of others, and open the way for novel and apparently very effective treatments. Whether it be the screening of carotid stenosis, the treatment of pericarditis, of heart failure, of chronic obstructive lung disease or spontaneous bacterial peritonitis, paradigm changes are conceivable. This selective review of the literature summarizes certain studies published this year.
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The year 2014 was marked by new therapeutic acquisitions in emergency medicine. Nephrolithiasis likelihood estimation should avoid imaging in patients at high risk. Therapeutic hypothermia post cardio-respiratory arrest has no benefit compared to a strategy of controlled normothermia. ⋯ Adding colchicine to standard treatment of acute pericarditis reduces the rate of recurrence. The D-dimerthreshold adjustment by age reduces the number of imaging in case of low or intermediate risk of pulmonary embolism. Finally, the speed of the initial management of septic shock is crucial to the outcome of patients, but an early invasive monitoring provides no benefit.
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The incidence of inguinal hernias in children is 1-4% with predominance in boys (10 to 1). Based on the data, 0.8-2.4% of premenstrual girls presenting with inguinal hernias have a complete androgen insensitivity syndrome (CAIS). On the other hand, 80-90% of girls with CAIS present uni- or bilateral inguinal hernias. Unfortunately, this burdened pathology is very rarely looked for by pediatricians, or paediatric surgeons.