Presse Med
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Antiplatelet treatment (platelet aggregation inhibitors) is essential in cardiovascular medicine today. Aspirin and, more recently, clopidogrel are among the most important treatments of cardiovascular diseases. ⋯ The principal risk of an antiplatelet treatment that inhibits clotting is bleeding, and the risk almost doubles when two treatments are combined. New platelet aggregation inhibitors, undoubtedly more efficacious, but also more likely to induce bleedings, will probably emerge.
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Reversible cerebral vasoconstriction syndrome (RCVS) is more frequent than previously thought and is probably underdiagnosed. The mean age of onset is 42 years, and it affects slightly more women than men. RCVS is attributed to a transient, reversible dysregulation of cerebral vascular tone, which leads to multifocal arterial constriction and dilation. ⋯ In our experience, it is not especially effective in severe RCVS. Relapses are possible but rare and have not yet been reported in prospective series. Although the exact pathophysiology remains speculative, strong recommendations against vasoactive substances appear prudent.
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In France, national incentives promote the development of morbidity and mortality conferences (M&MC) in hospitals. ⋯ The published studies viewed M&MC as a valuable tool for physician education and quality assurance, but the factors associated with their effectiveness require further study.
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Lymphangioleiomyomatosis is a rare pulmonary disease encountered almost exclusively in women of reproductive age. Pulmonary involvement is characterized by multiple thin-walled cysts in the lungs, recurrent pneumothorax, obstructive lung disorders, and progression to chronic respiratory failure over a mean period of 10 years. Certainty of diagnosis requires a lung biopsy, but international criteria have been proposed for a diagnosis without such a biopsy. ⋯ Hormone treatment is not recommended. Hopes are high for mTor inhibitors (sirolimus and everolimus) and treatment trials are currently underway. Lung transplantation must be considered when chronic respiratory failure occurs in patients younger than 60 years.
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Aneurysms of the ascending aorta carry a high risk of aortic dissection or rupture in the absence of surgical treatment. Aneurysms of the ascending aorta are classified into 2 distinct types according to their etiology and surgical treatment: aortic root aneurysms, in which the dilatation of the aorta involves the initial portion of the aorta and includes the sinuses of Valsalva and supravalvular aortic aneurysms, which involve the ascending thoracic aorta above the sinuses of Valsalva. Echocardiography and CT scan are the main exams in the evaluation of the diameter of the ascending aorta and its follow up. ⋯ Beyond 50mm, an aneurysm is at risk for complications. Supravalvular aortic aneurysms can be treated by a simple supracoronary tube graft unlike aortic root aneurysms in which replacement or repair of the aortic valve is often necessary. A family history and investigation of other members is essential in patients with aortic aneurysms.