Presse Med
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An imbalance between prostacyclin (PGI2) and thromboxane A2 is observed in patients with scleroderma. Iloprost is a stable analogue of PGI2 with a plasma half-life of 20-30 min. Intravenous iloprost is effective in the treatment of Raynaud's phenomenon related to scleroderma, decreasing the frequency and severity of attacks. ⋯ Inhaled iloprost is an effective treatment for NYHA class III pulmonary arterial hypertension, either idiopathic primary or associated with a particular condition, such as scleroderma. Intravenous iloprost improves kidney vasospasm in patients with scleroderma. The possible benefits of sequential intravenous iloprost on the natural course of scleroderma require further investigation.
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The incidence of atrial fibrillation increases rapidly with population age. Atrial fibrillation essentially presents a problem of long-term management. ⋯ Anticoagulation treatment is indicated in most cases. Radiofrequency ablation by pulmonary vein isolation is an unquestionably innovative treatment but is reserved for selected patients.
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Generalized anxiety disorder (GAD) is a condition that is common in the general population and in general practice; it is disabling and often unrecognized. Its recognition is difficult because of the need to differentiate between normal anxiety and the other psychiatric disorders with which it is often associated. The primary drugs used for GAD are the antidepressants that have been authorized for this indication (venlafaxine XR, paroxetine, and escitalopram). ⋯ Drug treatment of GAD must continue for a sufficiently long period (at least 6 months) to minimize the chance of a relapse. Cognitive and behavioral therapies (CBT) are as effective as antidepressants. They are often desirable, but their limited availability impedes their use as a first-line treatment.
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Botulism is a potentially fatal infectious disease induced by a neurotoxin secreted by Clostridium botulinum, a sporulated species of obligate anaerobic bacteria. This neurotoxin inhibits the normal release of acetylcholine in the synaptic cleft, inducing presynaptic neuromuscular blockade. The diagnosis is often difficult because of the range and the lack of specificity of the symptoms. ⋯ These two cases remind us of the necessity to keep botulism in mind when systemic atropinic symptoms are found together with generalized, progressive and extensive paralysis. The diagnosis is confirmed by electromyogram and serology. There is no specific treatment for botulism; only intensive care surveillance and symptomatic treatment improve survival.
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Comment Letter Historical Article
[The controversy concerning Friedrich Wegener].