La Revue du praticien
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La Revue du praticien · Oct 1994
Review[Treatment of bacterial meningitis in newborn infants and children].
Third generation cephalosporin as cefotaxime or ceftriaxone is the best first line treatment. Duration of treatment is 7 to 10 days in uncomplicated disease. Dexamethasone used very early--before or at the same time of the antibiotic injection--seems to decrease sensorial sequelae. ⋯ In newborns, morbidity is higher, due in part to brain abscesses. Therapeutic choice is not the same for materno-foetal and postnatal infection. Antibiotherapy duration is, at least, 15 days and 21 days for gram-negative bacteria.
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The placebo induces a significant analgesia on average in 35% patients with some variations according to the studied pathology and the modalities of the therapy. This placebo effect is especially influenced by the expectations and beliefs of the patient, the doctor, the environment and the quality of the doctor-patient relationship. As with a real psychogenic analgesia, this effect could partly result in a release of endogenous opioid substances. By a good relationship with his patient and a treatment corresponding to his expectations and his beliefs, the doctor induces a powerful placebo effect which increases the specific effects of his analgesic treatment.
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Myelodysplastic syndromes are clonal haemopathies known to exist in elderly people where they are classified into 5 categories: refractory anaemia, acquired idiopathic sideroblastic anaemia, refractory anaemia with excess of blasts, refractory anaemia with excess of blasts undergoing acute transformation, and chronic myelomonocytic leukaemia. Transformation into acute leukaemia is frequent. These syndromes seem to be rarer in children, but they are often misdiagnosed. ⋯ Studies of clonality and malignancy markers will in the near future enable us to distinguish between true preleukaemic states and polyclonal constitutional or virus-induced myelodysplasias, probably more frequent in children. The choice of treatment depends on the severity of the myelodysplastic syndrome, defined by the initial partial blastosis, the presence of cytogenetic anomaly and the certainty of clonality. In cases with poor prognosis, early bone marrow allograft is the only possible treatment.
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The antibiotic therapy in septic syndrome is most often empiric. Decisions and antibiotic choices should result from a careful analysis of past history and setting (hospital-acquired infections vs community acquired infections), risk factors specific to the host, and characteristics of the suspected infections focus: direct examination of body fluid specimens should be obtained rapidly to guide the empiric choice. ⋯ Changes in pharmacokinetics of drugs are usual in this context, and frequent dosing is necessary. While effective antibiotic therapy is a recognized prognostic parameter, antibiotics are only one part of therapy, besides supportive therapy of failing organs, and effective drainage or surgery of the infected focus, when feasible.
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La Revue du praticien · Dec 1992
Review[What have we learned from converting enzyme inhibitors on renin-angiotensin system?].
Angiotensin-converting-enzyme (ACE) inhibitors are now widely used to treat patients with high blood pressure or heart failure. The favourable results obtained with these inhibitors of the renin-angiotensin system suggest that angiotensin II has a noxious effect on the development and/or course of these diseases. ⋯ Their most severe side-effects are mostly foreseeable and therefore avoidable. Chronic blockade of the renin-angiotensin system increasingly seems to be a good therapeutic approach to the protection of the vital organs.