La Revue du praticien
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La Revue du praticien · Jun 2006
Review[Complications of central venous and indwelling catheterization].
Complications on Hickman central venous catheter and venous access ports Hickman central venous catheter and venous access ports are widely used in patients with hematology or oncology disorders. However, these long-term venous access devices can be the source of several kinds of complications that may compromise the functional and/or vital patient's prognosis. ⋯ Extravasation of corrosive drugs represents a very serious complication of long-term venous access devices. The surgical technique that uses early subcutaneous wash-out in acute extravasation injuries is simple and safe; it helps to reduce the severe sequelae of highly toxic drug extravasation for the patient.
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Still today, as for the time of Charcot, multiple sclerosis is defined by pathology with the presence of inflammatory demyelinating foci ("plaques") disseminated in the white matter of the central nervous system (CNS). Each lesion follows its genuine course with an acute formation followed by a more or less complete regression whereas new lesions are forming elsewhere in the CNS throughout the disease duration. A permanent dynamics of the inflammatory activity, substratum of the lesional "dissemination in space and time" characteristic of the disease, is therefore operating. ⋯ During the progressive phase, be it secondary or primary, macroscopic atrophy and axonal loss, the main explanation of the irreversible neurological disability and the expression of the diffuse, chronic and progressive degeneration of the CNS, are emerging to the first place. Persisting controversies are many. Are there several distinct immunohistopathological patterns of the disease or do they correspond to different moments of the same disease? Is there a continuum between classic MS and pathological variants such as Marburg's disease, Balo's concentric sclerosis, Schilder's disease, and Devic's acute neuromyelitis optica or are there distinct nosological entities? As for autoimmunisation which leads to the selective destruction of myelin, is it primary or secondary to an oligodendrocytic apoptotic process?
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Hemorrhagic shock generates a prolonged alteration of organ perfusion due to the decrease in oxygen delivery. Hemorrhagic shock is mainly due to three etiologies: traumatology, gastrointestinal bleeding and high risk surgery. If intensive cares are not rapidly performed, severe complications occur, as organ failure with a high mortality rate. ⋯ Priority during initial treatment is to restore tissue perfusion and achieve haemostasis in vital functions. Fluid resuscitation and transfusion are common to every case of hemorrhagic shock but the strategy to localise the hemorrhage and stop the bleeding differs between the situations. Key factors in the management of hemorrhagic shock are the communication between surgical, anaesthetic, and critical care teams and the application of pathology.
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Altered states of consciousness are a common reason for visits to the emergency room and admission to intensive care unit. Management of unconscious patient can be difficult because the potential causes of an altered mental status are considerable and the time for diagnosis and effective intervention is short. ⋯ Technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. The prognosis for recovery depends greatly on the underlying etiology as well as its optimal treatment, which seeks to preserve neurologic function and maximize the potential for recovery by reversing the primary cause of brain injury, if known, and preventing secondary brain injury from anoxia, ischemia, hypoglycemia, cerebral edema, and electrolyte disturbances.