Revue médicale de Liège
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Revue médicale de Liège · Feb 2019
Case Reports[The use of ExtraCorporeal Membrane Oxygenation (ECMO) in severe hypothermia associated with cardiac arrest].
The use of extracorporeal membrane oxygenation (ECMO) in severe hypothermia associated with cardiac arrest has become a more frequent warming technique in specialized centers over the years with better survival outcomes compared to traditional rewarming methods. We show that a full recovery is possible, even after prolonged resuscitation. We report the case of a 36-year old male who survived approximately 4 hours of cardiopulmonary resuscitation following an unknown duration of asystole in the context of severe accidental hypothermia (24°C). ⋯ Although prolonged out-of-hospital cardiac arrest has low survival rates and asystole is not generally considered as an indication for extracorporeal cardiopulmonary resuscitation (ECCPR), associated hypothermia can be a predictor of a possible positive outcome when ECMO is used as it reduces the metabolism and protects the brain, thus leading to "miraculous" recoveries with no neurological sequelae. This case demonstrates yet again the importance of advanced rewarming techniques such as ECMO in the outcome of patients with severe accidental hypothermia, even after prolonged and refractory out-of hospital cardiac arrest and when "no-flow" time is uncertain. It also highlights the need for accidental hypothermia treatment algorithms, especially in hospitals capable of ECMO rewarming, to enable more rapid decision-making.
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Revue médicale de Liège · Sep 2018
[Trimbow® : twice-daily triple combination for the treatment of COPD].
Single-inhaler triple therapy in extrafine solution combining an inhaled corticostéroid (ICS), the dipropionate of beclométasone, a long acting ß2-agonist (LABA), the fumarate of formoterol and an long-acting muscarinic antagonist (LAMA), the bromide of glycopyrronium, was developed for the treatment of the chronic obstructive pulmonary disease (COPD). Trimbow® is the first triple therapy in spray with fixed dose and containing 3 pharmacological agents (LABA-LAMA-ICS). ⋯ These results justify its use in severe and very severe COPD with exacerbations in spite of treatment by LABA-LAMA or LABA-ICS. In this article, we present a brief synthesis of the main recent clinical trials on Trimbow®, its comparison with other pharmacological agents/associations regularly used in the treatment of COPD, as well as some practical information on its use in routine.
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The primary vaginal melanoma is a rare aggressive tumour with a poor prognosis. The average age at diagnosis is 60, and there are no known risk factors. The establishment of a classification system and treatment protocols are made difficult because there are so few cases. ⋯ There were metastatic lymph nodes in the lumbo-aortic region, but no extension to bone or viscera. She was treated with nivolumab as monotherapy. Clinical and radiological evolution were both favourable, and the treatment was well tolerated.
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The rupture of an intracranial aneurysm is a sudden, unpredictable and potentially severe event. The responsible aneurysm has to be excluded from the cerebral circulation to avoid recurrence. ⋯ How to react to these fortuitous discoveries is unclear, because the risk of rupture is difficult to estimate. We present our approach to patients facing this situation and the decision-making process.
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Acute mesenteric ischemia is a real life-threatening emergency. Mode of presentation is severe abdominal pain with sudden onset. The etiology is most of the time embolus coming from the heart or thrombosis of atherosclerotic vessel wall concerning the superior mesenteric artery. ⋯ Treatment consists of revascularization by open surgery or endovascular approach. Bowel resection may be necessary, as well as delayed second look surgery. This paper aims to review etiologies and therapeutics options for acute mesenteric ischemia.