Revue médicale suisse
-
Severe sepsis and septic shock are frequent pathologies accounting for approximately 11% of all admissions in intensive care units (ICU). In the United States, between 1979 and 2000 the incidence of sepsis increased by 8,7% annually and septic shock) remains the second most frequent cause of death in non-coronary ICU. Although our understanding of the host defense mechanisms against infections and of the pathogenesis of septic shock have progressed during the last decade, these progresses have not yet yielded the anticipated advantages. Recent new therapeutic approaches, especially early-goal directed therapy, activated protein C (drotrecogin alpha activated), moderate doses of corticosteroids and intensive insulin therapy have given encouraging results.
-
Revue médicale suisse · Mar 2006
Review[The role of aspirin in the primary prevention of cardiovascular disease].
For persons without cardiovascular disease, the benefit of aspirin in primary prevention has been controversial until the recent publication of several major randomized controlled trials. Since then, several medical societies recommend that clinicians discuss aspirin prevention with adults at high cardiovascular risk. Patients with low cardiovascular risk are unlikely to benefit from aspirin, as potential harms (hemorrhagic strokes, gastrointestinal bleedings) may outweigh benefits. Aspirin should be recommended in primary prevention only in patients with a 10-year cardiovascular risk > or = 10% or in diabetic patients aged > or = 40 years with a concomitant cardiovascular risk factor, after assessing contraindications for aspirin and individual's preferences for the risks and benefits associated with aspirin.
-
Revue médicale suisse · Feb 2006
Review Case Reports[Partial Horner's syndrome and facial pain: a diagnosis one should not miss].
Internal carotid artery dissection typically manifests as an unilateral facial or latero-cervical pain, is often accompanied by an oculosympathetic palsy (myosis and palpebral ptosis) and may be followed by cerebral or retinal ischemia. Deficits of the IXth to XIIth cranial nerves or a pulsatile tinnitus have been described. ⋯ Conventional angiography has been replaced by magnetic resonance techniques as gold standard. In this article, we describe the case of a patient evaluated at our outpatient clinic and review briefly the literature on this topic.
-
Revue médicale suisse · Jan 2006
Review[The prognosis of pulmonary embolism: are there practical implications for patient management?].
There is growing evidence that outpatient treatment is safe and effective for many patients with non-massive pulmonary embolism. Despite this evidence, the vast majority of patients with non-massive pulmonary embolism continue to be treated in an inpatient setting. A major barrier to outpatient treatment has been the lack of explicit criteria to identify patients with pulmonary embolism at low-risk of adverse medical outcome. This article discusses new risk stratification tools for pulmonary embolism such as echocardiography, biomarkers, and clinical prognostic scores, and their potential application for patient management.