Presse Med
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ANTIREFLUX SURGERY: Peri and postoperative morbidity is higher with Nissen fundoplication than with a 180 degrees posterior fundoplasty (Toupet procedure) which carries the risk of a compromised result with time. Although a 270 degrees posterior gastric valve may be the best technique, the surgeon's skill looks more important than the procedure used, especially for laparoscopic surgery. Its advantages include reduced postoperative pain, shorter hospital stay and convalescent time.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Catheter infection in intensive care: influence of systematic replacement of central venous catheters on a guide wire every 4 days].
Determine whether systematic replacement of central venous catheters on a guide wire every 4 days leads to a lower rate of catheter infection. ⋯ We do not recommend systematically replacing catheters on a guide wire for the prevention of catheter infection. This procedure may however be indicated in case of suspected catheter infection as no mechanical of infectious complications occurred.
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Case Reports
[Continuous intrathecal injection of baclofen in generalized tetanus. A therapeutic alternative].
In France, tetanus is diagnosed predominantly in the elderly due to the absence of vaccination in this population. Mortality remains high and is mainly related to complications secondary to prolonged hospitalization, intravenous administration of benzodiazepines, and at times curares. Baclofen, a selective agonist of GABAB receptors, directly counteracts the effects of the tetanic toxin. ⋯ Continuous intrathecal administration of barclofen appears to be a valuable alternative therapy in tetanus. This new therapeutic modality promises to improve the prognosis of this condition, especially in the elderly.
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Intravenous immunoglobulins have been shown to be effective in the treatment of immunologically mediated thrombocytopenia. Several articles have been published on the positive effect of immunoglobulins in sepsis-related death. We retrospectively studied the effects of intravenous immunoglobulins used during septic shock thrombocytopenia over a 5-year period in a polyvalent intensive care unit. ⋯ Although we were unable to demonstrate a significant difference in the effects of immunoglobulins on platelet level and mortality, the trend during this evaluation was comparable with that reported in the literature. For transfusion, and although the results were not significant, a notion of reduced risk was evident. Prospective trials are needed to confirm these observations.