Presse Med
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A FREQUENT AND SEVERE EVENT: The incidence and the pathogenic mechanisms of cardiac complications in general surgery patients are now well described. Acute myocardial necrosis, the most frequent complication, is observed in 3 to 5% of patients at risk. Most are silent subendocardial lesions, but may have a short-term or mid-term life-threatening effect in these surgery patients. ⋯ The immediate postoperative period is characterized by increased left ventricular load and metabolic disturbances, increased release of catecholinergic mediators and hypercoagulability, factors related to the effect of anesthesia on circulation and surgical stimuli. These modifications compromise the energy balance in the myocardium and favor the development of left ventricular failure. ECG RECORDINGS: Continuous recordings in the postoperative period have shown that although the number of episodes of myocardial ischemia is not affected during surgery, their number doubles during the postoperative period, a factor predicting postoperative infarction.
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Review
[Postoperative management. Critical care in intra-abdominal infection after surgical intervention].
UNDERESTIMATED FREQUENCY: Post-operative intraabdominal infections usually appear as abscesses or injury of the bowel, either alone or in combination. These complications of frequently underestimated frequency are characterized by high mortality. ⋯ ALARM SIGNS: In a patient who recently underwent abdominal surgery, the onset of abnormal signs must be considered as an alarm which imposes ruling out intraabdominal complications. Unexplained multiple organ failure or septic shock in the post-operative period of intraabdominal surgery must lead to considering explorative laparotomy.
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A MAJOR CHALLENGE: Management of post-operative pain is insufficient. One out of 2 patients suffers intense or very intense pain during the first days after surgery. The inefficacy of analgesic therapy is related to lack of a sufficiently organized pain-relief protocol. ⋯ LOW COST: Optimally, the entire procedure, integrated into an overall quality assurance program, is directed by one reference physician assisted by a nurse specially qualified in pain relief. The overall financial burden, including drug costs, material and health care personnel is minimal. In French units, it has been estimated at around 10 to 20 F per patient per day.
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A PUBLIC HEALTH CHALLENGE: Cerebral vascular events are the third most frequent cause of death in the adult population and the number one cause of disabilities, a public health challenge both in terms of health care service and health care expenditures.
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GENERAL DATA: Human herpesvirus 6 (HHV-6) infects 90% of the human population before the age of 4 years, recognized as a childhood disease (sixth disease) or with no clinical manifestation. HHV-6 DNA has partial homogly with cytomegalovirus DNA. Two variants, A and B, are known. ⋯ POORLY UNDERSTOOD NATURAL HISTORY: In organ transplant or hematopoietic stem cell recipients, the natural history of HHV-6 infection is difficult to establish because of small sample size in certain series, the lack of controls both for patients and samples and differences in the sensitivity of diagnostic tests. Serology is non-specific and cannot be used to study reinfection. Different studies have relied on culture and isolation, detection of viral antigens with monoclonal antibodies and PCR using mononucleated cells, serum and plasma.