Presse Med
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In central sleep apnoea syndrome (SAS), there is a dysfunction in central ventilatory command. Patients with central SAS can exhibit symptoms and complications linked to unstable sleep caused by apnoea and certain specific mechanisms (chronic and intermittent hypoxia). Central SAS is linked to several diseases which should be investigated before treatment. ⋯ Possible treatments include nocturnal non invasive ventilation and/or oxygen, and oral medications. Chronic heart failure with LVEF<45% is a contraindication to servo-assisted ventilation. Several observational French studies are currently enrolling patients to gain knowledge on disease and the impact of treatment.
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As population grow older, chronic diseases are more prevalent. It leads to an increase of hospitalization for acute decompensation, sometimes iterative. Management of these patients is not always clear, and care provided is not always proportional to life expectancy. Making decisions in acute situations is not easy. ⋯ Practical use of these scores might help management of these patients, in order to initiate appropriate reflexion and palliative care if necessary.
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Hepatocellular carcinoma related mortality is one of the highest among all cancers. Ninety percent of all hepatocellular carcinoma develop in the context of liver cirrhosis. Liver cirrhosis is not recognized prior to the diagnosis of hepatocellular carcinoma in 25 % of the cases, despite the existence of risk factors. ⋯ Ultrasound screening for hepatocellular carcinoma every 6 months increases chances to diagnose HCC at an early stage amenable to curative treatment, and increases survival. Interval greater than 7months between ultrasound imaging has a significant negative impact on survival. All patients diagnosed with cirrhosis have to perform an ultrasound screening for hepatocellular carcinoma and comply with the six months rule.