Presse Med
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Medical problems during flight have become an important issue as the number of passengers and of miles flown continue to rise. Cabin pressurization causes hypoxia, hypobaria and decreased humidity, which are responsible for most medical incidents occurring during flight. Worldwide daily medical incidents are estimated at 350, i.e., one per 14,000 to 39,600 passengers. ⋯ Passenger flights carry medical equipment and drugs, determined according to number of passengers and the flight distance. The conditions of intervention are codified: "good Samaritan" laws protect professionals from liability when they choose to aid others who are injured or ill. Current recommendations call for physicians to identify themselves, request an interpreter when necessary, obtain the patient's consent, conduct out examination, inform the patient, family members and crew members of the situation, contact ground medical staff, use well-known procedures, consider flight diversion, and write up a case report.
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Treatments of systemic necrotizing vasculitides have progressed markedly over the past few decades. The first attempts to obtain better-adapted therapeutic strategies evaluated the indications of conventional drugs, and their abilities to prolong survival and prevent relapses, while decreasing the severity and number of side effects. ⋯ Recent therapeutic strategies include immunomodulating methods, like plasma exchanges, or products, like intravenous immunoglobulins, or, more recently, new agents called biotherapies. Some of the latter have achieved promising effects, for example, anti-tumor necrosis factor-alpha and anti-CD20 monoclonal antibodies, and are now being evaluated in prospective trials.
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Transthoracic echocardiogram is the best tool for the screening of PH. When PH is suspected, the diagnosis must be confirmed by a right heart catheterization, and a vasoreactivity testing with NO must be performed in all cases of pulmonary arterial hypertension. ⋯ Routine screening is warranted in systemic sclerosis, HIV infection and portal hypertension. All patients with PH must be referred to a reference or a competence center for PH.
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Treatment of pulmonary arterial hypertension (PAH) attempts to counteract the deleterious effects of pulmonary vasoconstriction, pulmonary vascular remodeling, thrombosis and right heart dysfunction. The development of therapies targeting the endothelial dysfunction (endothelin-receptor antagonists, prostacyclin derivatives, phosphodiesterase type 5 inhibitors) has markedly improved patients' prognosis. Intravenous epoprostenol remains the first line treatment for the most severe patients (NYHA [New York Heart Association] functional class IV). ⋯ Recommendations in pediatric PAH are equivalent to those proposed in adults. Randomised studies are rare and pharmacokinetics data for available drugs are scarce. The impact of these new therapeutic approaches on long-term survival of patients with PAH is a major challenge in the near future.
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Infective endocarditis (IE) is a severe form of valve disease still associated with a high mortality (10-26 % in-hospital mortality). IE is a rare disease, with reported incidences ranging from 3 to 10 episodes/100,000 people per year. The epidemiological profile of IE has changed over the last few years, with newer predisposing factors - valve prostheses, degenerative valve sclerosis, intravenous drug abuse (IVDA), associated with the increased use of invasive procedures at risk for bacteremia. ⋯ HF is the most frequent and severe complication of IE. Unless severe comorbidity exists, the presence of HF indicates early surgery. The new guidelines give for the first time informations not only on the indications of surgery, but also on the timing of surgery.