La Revue du praticien
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Adrenal insufficiency can be either primitive as the result of a destruction of the glands or secondary to a corticotropic failure. Adrenal insufficiency can appear as an acute event or in contrast arise progressively. An acute adrenal insufficiency can occur any time and threatens the vital prognosis. ⋯ The treatment of adrenal insufficiency includes substitutive doses of mineralo and/or glucocorticoids and, as often as possible, etiologic therapy. For this reason, as soon as the diagnosis of adrenal insufficiency has been done, a main point is to determine the cause of the endocrine failure. Indeed, some diseases responsible for adrenal deficiency, among a progressively extending list of etiologic factors, can benefit for a specific treatment.
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Falciparum malaria remains a major killer in developing countries, particularly for African children. The sequestration of parasitized erythrocytes in the deep microvasculature is mostly mediated by their cytoadherence to activated endothelium. Proinflammatory cytokines and particularly tumor necrosis factor contribute to severe disease but the pathophysiology of coma remains poorly understood. ⋯ In non immune adults, pictures of severe sepsis with shock, acute renal failure and respiratory distress syndrome are common and often associated with bacterial coinfection. Although chemotherapy of malaria is challenged by the continuing evolution of antimalarial resistance, quinine remains the first-line drug for severe disease. The optimization of symptomatic management of severe malaria remains a major concern in developing countries.
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The pleura is characterized by its great capacity to drain liquids and particles from the pleural space and a strong inflammatory potential. Mesothelial cells react to various endogenous or exogenous agents, which are absent from the pleural space in normal conditions: air, blood, organic and inorganic particles. The pleura is a target organ, for specific lesions (pleural plaques, mesothelioma) induced by mineral fibers and for non-specific inflammatory lesions from multiple causes (drugs, systemic diseases, infections). The risk for diseases of the pleura appears disproportionate compared with its physiological role.
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Most probably common in emergency departments, but still not well studied in this context, the disorders formerly called "hysteria" are now included in the group "Somatization, undifferentiated somatoform, conversion and dissociative disorders" (SSCD disorders) DSM IV. Their common presentation is that of idiopathic somatic symptoms linked with mental disorders. In the emergency department these symptoms confront physicians who generally do not have extensive psychiatric training. ⋯ The possibilities of discussing such psychogenesis in the context of the emergency department are slight, and the best course is often to adopt a pragmatic and prudent medical approach. An essential point is respect of the patient and his ideas. The legal provision, which already exists, for the presence of psychiatrists in emergency departments should lead to physician-psychiatrist cooperation that would be beneficial for these patients.
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La Revue du praticien · Apr 1995
Review[Treatment of acute sigmoid diverticulitis and development].
In acute diverticulitis of the sigmoid colon, the initial therapeutic decision is wether to employ medical or surgical treatment and, thereafter, wether elective resection of the involved bowel is needed. According to the criteria used for the diagnosis of diverticulitis and to the length of the medical follow-up 10 to 25 per cent of patients with diverticulosis will develop some form of peridiverticular inflammation. Adequate treatment of diverticulitis requires antimicrobial therapy directed against both facultative and obligate anaerobic gram-negative bacteria. ⋯ Urgent operation or percutaneous drainage is required for paracolic abscess not confined to the mesocolon. Common indications for delayed operations are residual abscesses, stenosis, fistulae, well defined recurrent diverticulitis and failure to exclude a colonic carcinoma. However, recent prospectives studies have demonstrate that the high frequency of disease recurrence justify to propose prophylactic sigmoidectomy after the first attack of diverticulitis, especially if the patient is younger than 50 years, obese or immuno-compromised.