Presse Med
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Churg-Strauss syndrome is a systemic necrotizing vasculitis involving small and medium-sized vessels. Classic features include asthma and hypereosinophilia. Antineutrophil cytoplasm antibodies (ANCA) are detected in about 40% of patients. ⋯ LTRA for asthma patients should be prescribed with great care, especially in cases of atypical or rapidly aggravated asthma. The onset of Churg-Strauss syndrome in patients treated with LTRA usually requires that they stop this treatment. Prescription of LTRA In patients with Churg-Strauss syndrome should be discussed with specialists.
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Vasculitides are defined by inflammation of blood vessel walls leading to vascular stenosis or occlusion, with various degrees of fibrinoid necrosis of the media and inflammatory infiltration, mainly neutrophilic and sometimes granulomatous. Various classifications of the vasculitides have been proposed. ⋯ In practice, primary systemic vasculitides are classified according to their clinical presentations, their precise histological features, and the size of the predominantly affected vessels. Some small-vessel vasculitides are associated with the presence of ANCA: 90% of patients with systemic Wegener's granulomatosis (mainly ANCA with cytoplasm labeling on indirect immunofluorescence and proteinase 3 specificity), 80% of the subjects with microscopic polyangiitis (mostly pANCA with myeloperoxidase specificity), and more than one third of those with Churg-Strauss syndrome (mostly pANCA).
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Imaging of ANCA-associated vasculitides principally shows nonsystematized alveolar opacities, predominantly central, that suggest alveolar hemorrhage, as well as uni- or multifocal alveolar opacities of variable interpretation, and nodules, including cavitary nodules. Other signs, observed more rarely on imaging, are interstitial lung diseases, tracheobronchial involvement, and pulmonary hypertension. ⋯ The most frequent pulmonary signs of Churg-Strauss syndrome on computed tomography are ground glass areas or parenchymal consolidation in dispersed bands or with a predominantly subpleural distribution that expresses eosinophilic interstitial and alveolar infiltration. Alveolar hemorrhage is the most common expression of microscopic polyangiitis.
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Acute infectious diarrhea has various causes: bacterial diarrhea with invasive or toxigenic mechanisms, especially frequent in hot regions and in travelers; viral diarrheas, frequent and cosmopolitan in children but also adults; and parasitic diarrhea, less frequent, and generally in subtropical areas. The major concerns involve the risk of complications, essentially dehydration and malnutrition, especially in vulnerable patients: young children, the elderly, and patients with immunosuppression, for whom rehydration is urgent. Diagnosis of diarrhea requires clinical assessment and history: underlying illnesses, severity of symptoms, presence and extent of dehydration and other clinical symptoms, travel history, known outbreaks, and pathogenic mechanism (invasive or toxigenic). Initial therapy should always include oral or parenteral rehydration; antimotility agents are generally not indicated; specific antibiotic treatment is not systematically indicated, except for invasive or dysenteric diarrhea and in immunosuppressed patients.
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Comparative Study
[Impact of a hospice home visit team on unwanted hospitalization of terminally-ill patients at home in acute medical emergencies].
This study was undertaken to evaluate the impact of paramedical hospice specialists on hospitalization of terminally-ill patients in acute medical emergencies. ⋯ A team of paramedical hospice specialists, acting on request of the SAMU, provides a concrete and useful response to problems of unwanted hospitalization in acute emergencies for home-based terminally ill patients. This type of organization is consistent with respect for the patient's choice to remain at home until the end of life. Prevention of unwanted hospitalization and heroic measures should undoubtedly result in cost savings more than sufficient to fund this program.