Presse Med
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GENERAL PRINCIPLES: The first step is to determine the absence or the minimal nature of the functional impairment from history taking and, for doubtful cases, with an exercise test. Therapeutic indications differ depending on the valvular lesion. AORTIC STENOSIS: Surgery is indicated only for severe aortic stenosis or in cases with a particular risk. ⋯ Careful patient selection is the rule. Surgery is often needed for cases with multiple valve involvement where different therapeutic options can be used for the different valves. The dominant lesion and the degree of heart dilatation and dysfunction guide decision making.
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AN INDEPENDENT RISK FACTOR: Pathophysiological and epidemiological data show that fibrinogen is an independent risk factor for atherosclerosis with a synergistic effect on classical risk factors.
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Comparative Study
[Circulatory assistance while waiting for heart transplantation. Patient selection and choice of the assist system].
TWO CLINICAL SITUATIONS: Mechanical circulatory assistance can be indicated in two clinical situations: i) patients on the waiting list for heart transplantation who have chronic heart failure unresponsive to drug therapy and whose clinical status worsens; ii) patients with acute heart failure.
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Collapsing glomerulopathy is a form of focal and segmental glomerulosclerosis which occurs preferentially in black people. It causes severe nephrotic syndrome and quickly progresses towards end-stage renal failure. ⋯ Collapsing nephropathy is the cellular type of focal and segmental glomerulosclerosis. The main etiology is the human immunodeficiency virus. A viral infection may be involved in its pathogenesis. Other viruses could be linked with this nephropathy. This case report relates a case associated with a cytomegalovirus viruria. The clinical course might be related with the antiviral treatment.
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A RECOGNIZED CAUSE OF BUCCAL APHTHOSIS: Nicorandil is the leading drug in a new pharmacology class of well tolerated anti-angina products with vasodilating action. The first cases of buccal aphthosis or ulcerations induced by nicorandil were reported in 1996. Among drugs inducing buccal aphthosis or ulcerations, the largest body of information available on reported cases concern nicorandil. ⋯ The lesions develop for about 3 to 36 before diagnosis and the delay to onset of signs after initiating nicorandil treatment is 15 days to 24 months (generally 2 months). Lesions basically develop after high-dose treatments and, for a few cases, after increasing the dosage. Cure is obtained in all cases after 1 to 12 weeks.