La Revue du praticien
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Recurrent fevers in children are common, mainly due to viral (particularly in day care centers), or to bacterial (urinary tract upper and lower respiratory) infections. The diagnosis of recurrent hereditary fever is now possible on the basis of clinical features, biochemical and genetic tests. Familial Mediterranean Fever (FMF) remains the most frequent disorder of this group, which includes now three other entities: TNF receptor associated periodic syndrome (TRAPS), the hyperIgD syndrome(HIDS) and the Muckle-Wells syndrome.
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In patients with acute gastrointestinal bleeding, initial management includes emergency cares to restore or maintain circulatory stability, while the endoscopic examinations often determine the origin of bleeding. The most recent advances in this management concern early administration of proton pump inhibitors in bleeding ulcers, early administration of vasoactive drugs in patients with acute bleeding related to portal hypertension and the development of endoscopic therapy reducing the need for surgery. In all cases, an efficient collaboration between emergency physicians, gastroenterologist and surgeon is needed.
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Acute abdominal pain is frequent and often distressing. This symptom must start a clinical investigation with mostly questioning and abdominal palpation for correct diagnosis and decision making. Half of the patients have either appendicitis or non-specific abdominal pain.
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The aim of blood transfusion therapy is to supply specific labile products to patients in quality and in quantity. Different basic blood products are available: red blood cell concentrates, platelets concentrates and fresh frozen plasma, and according to their biological parameters, some of them can be selected and secondly adapted. Therefore, because some blood products are very rare and expensive, it is not possible to systematically use blood products having all the specifications. ⋯ The benefice risk ratio must be continuously measured, because these human products have some adverse effects: specially immunologic reactions and transfusion transmitted diseases. The systematic cell blood product leukoreduction since April 1st 1998 in France, allowed us to decrease these risks and to obtain a good tolerance. The hypothetical prion blood product transmission must be taken into consideration by plasma leukoreduction and limiting the blood product transfused number, in the respect of each specific clinical situation.