Presse Med
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Acute respiratory distress syndrome in adults (ARDS) is a relatively frequent disease, the mortality of which has diminished considerably in recent years. The long-term outcome of patients who have survived ARDS has been studied extensively and should in the future be taken into account in assessing new treatment modalities. The long-term respiratory sequelae are generally minimal and moderately disabling. ⋯ Appropriate management for these symptoms remains to be determined. Critical care units must now work at preventing the onset of these disorders, by limiting the treatments at risk when possible and by identifying these disorders before discharge to prepare for optimal subsequent management. Patients with ARDS are only a subgroup of more severe illness among all patients in critical care departments.
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Henoch-Schönlein purpura (HSP) is a systemic IgA vasculitis affecting small vessels. HSP usually affect children whereas it is rare in adults (150 to 200 for 1) in which the disease is often more serious with more frequent and severe nephritis. Prevalence of adult PR is unknown and its annual incidence is 1 in 1 million. ⋯ Short term outcome depends on the severity of the gastro-intestinal manifestations. The long term prognosis is heavily dependent on the presence and severity of nephritis. Studies with prolonged follow-up show up to one third of adult patients reaching end stage renal failure.
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Tako-tsubo syndrome is a new diagnostic entity, still little known. Also called transient left ventricular apical ballooning, stress cardiomyopathy, and neurogenic myocardial stunning, it mimics myocardial infarction, combining chest pain with electrocardiographic changes and a moderate rise in the serum markers of necrosis. Angiography of the coronary artery is normal while that of the left ventricle shows ballooning and basal hyperkinesis. This disorder appears to concern 1 to 2% of patients admitted for suspected myocardial infarction. The aim of our study was to describe the characteristics of this syndrome on the basis of our clinical experience and to analyze the current physiopathological explanations. ⋯ Tako-tsubo syndrome has a favorable prognosis in the intermediate and long term, although severe complications may occur. The etiology of this syndrome is unknown, but it must be considered as a differential diagnosis of acute coronary syndrome in elderly women with normal coronary angiography.