Presse Med
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Review
[Postoperative management. Critical care in intra-abdominal infection after surgical intervention].
UNDERESTIMATED FREQUENCY: Post-operative intraabdominal infections usually appear as abscesses or injury of the bowel, either alone or in combination. These complications of frequently underestimated frequency are characterized by high mortality. ⋯ ALARM SIGNS: In a patient who recently underwent abdominal surgery, the onset of abnormal signs must be considered as an alarm which imposes ruling out intraabdominal complications. Unexplained multiple organ failure or septic shock in the post-operative period of intraabdominal surgery must lead to considering explorative laparotomy.
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A MAJOR CHALLENGE: Management of post-operative pain is insufficient. One out of 2 patients suffers intense or very intense pain during the first days after surgery. The inefficacy of analgesic therapy is related to lack of a sufficiently organized pain-relief protocol. ⋯ LOW COST: Optimally, the entire procedure, integrated into an overall quality assurance program, is directed by one reference physician assisted by a nurse specially qualified in pain relief. The overall financial burden, including drug costs, material and health care personnel is minimal. In French units, it has been estimated at around 10 to 20 F per patient per day.
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A PUBLIC HEALTH CHALLENGE: Cerebral vascular events are the third most frequent cause of death in the adult population and the number one cause of disabilities, a public health challenge both in terms of health care service and health care expenditures.
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Review Comparative Study
[General or locoregional anesthesia: which to choose for a patient at risk?].
HIGH RISK SITUATIONS: The risk of surgery is higher in certain situations (subjects over 70 years of age, underlying disease states). Procedures lasting more than 3 hours or performed in emergency situations also increase the risk. The question is often raised as to which type of anesthesia, general or locoregional, is the most appropriate to lower the risk of complications in such situations. ⋯ It also eliminates the neuroendocrine response to surgical stress. MODEST EFFECT: Only a few precise parameters can differentiate risk between general and locoregional anesthesia. However, the type of anesthesia has little effect on overall morbidity or mortality, which depend more on the general status of the patient and the surgical procedure performed.
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GENERAL DATA: Human herpesvirus 6 (HHV-6) infects 90% of the human population before the age of 4 years, recognized as a childhood disease (sixth disease) or with no clinical manifestation. HHV-6 DNA has partial homogly with cytomegalovirus DNA. Two variants, A and B, are known. ⋯ POORLY UNDERSTOOD NATURAL HISTORY: In organ transplant or hematopoietic stem cell recipients, the natural history of HHV-6 infection is difficult to establish because of small sample size in certain series, the lack of controls both for patients and samples and differences in the sensitivity of diagnostic tests. Serology is non-specific and cannot be used to study reinfection. Different studies have relied on culture and isolation, detection of viral antigens with monoclonal antibodies and PCR using mononucleated cells, serum and plasma.