Revue médicale de Liège
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Revue médicale de Liège · May 2007
Review[Recent therapeutic advances in intensive care: update on severe sepsis/septic shock and on pulmonary embolism].
Septic shock and pulmonary embolism remain leading causes of death in intensive care units. Recent therapeutic advances have contributed to decrease the mortality rate of septic shock. Among these, early goal directed hemodynamic therapy, corticoid and activated protein C are the most efficient. ⋯ Its main objective is to decrease mortality rate of sepsis by 25% in the next five years. The diagnostic strategy of pulmonary embolism has been improved by the use of validated algorithms using clinical probability, d-dimers, angioscan and venous doppler. The growing use of low molecular weight heparin has also improved and facilitated the therapeutic management of pulmonary embolism while indication of fibrinolysis in presence of right ventricular dysfunction, but without shock, remains controversial.
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Revue médicale de Liège · Feb 2007
[The question of secondary medical transfer in Belgium: the experience conducted at the University Hospital Center of Liège].
Evaluation of the aid of an emergency mobile unit to transfer monitorized patients to a University hospital, in the political context of regional care network offering highly qualified but restricted tertiary area centres, and an open prospective study conducted over the 5 first months in 2006. The call regulation was assessed by the emergency physician of the transfer team and all missions were concluded with an evaluating report. An amount of 197 requests were taken into account from which 80 % were addressed between 8 am and 8 pm. ⋯ Mortality during such a transfer activity was absent. Medical transfer unit allows the development of specific high qualified network resources owing to the secondary addressee of patients. However, the weak incidence of complication questions the practice of systematic medical accompanying during such transfers.
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Revue médicale de Liège · Jan 2007
Review[Behavioural assessment and functional neuro-imaing in vegetative state patients].
Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The gold standard remains the Glasgow Coma Scale (GCS, Teasdale and Jennet, 1974), with the Glasgow Liège Scale (GLS, Born, 1988) adding standardized assessment of brainstem reflexes. ⋯ We showed that for the assesment of the presence of visual pursuit, using a moving mirror is better suited than using a moving object or person. The clinical diagnosis can be confirmed by cerebral positron emission tomography studies objectively quantifying residual metabolic activity in vegetative and minimally conscious patients. Ongoing studies evaluate the prognostic value of functional magnetic resonance imaging studies in these challenging patient populations.
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Revue médicale de Liège · Jan 2007
Review[Monitoring the depth of anaesthesia: why, how and at which cost?].
The precise titration of anaesthetic agents is necessary to avoid the consequences of a too light depth of anaesthesia such as unexpected intraoperative awareness, as well as a too deep level of anaesthesia, which can be deleterious in terms of postoperative morbidity and mortality. The clinical evaluation of the depth of anaesthesia is poorly sensitive and specific. It does not permit to distinguish between pharmacodynamic components of anaesthesia. ⋯ They are efficient at reducing the incidence of unexpected intraoperative awareness, adjusting anaesthetic depth at an individual scale, predicting the time needed for recovery, allowing early extubation of patients, reducing their length of stay in the post anaesthesia care unit, and limiting the number of episodes of peroperative over and under dosage of anaesthetic agents. The knowledge of conditions that may impede the accurate interpretation of those indices is mandatory for an optimal use. Although undoubtedly beneficial for the patients, the use of those monitors is frequently responsible for supplementary' costs, particularly when the procedure is short.
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Colorectal cancer is the second leading cause of death in Northern countries and need a national screening program to reduce mortality and improve quality of life. Screening has to be cost-effective and acceptable for patients. Many screening tools, invasive or not, are existing and often debated: FOBT, sigmoidoscopy and complete colonoscopy. New tools are in development and have to be evaluated in current practice: virtual colonoscopy, new endoscopic technologies, DNA on faeces or proteomics with markers in serum.