Revue médicale suisse
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Revue médicale suisse · Nov 2008
Review[Herpes zoster and post-herpetic neuralgia in older adults].
Varicella-Zoster virus is responsible for chickenpox and, after reactivation, herpes zoster. Herpes zoster causes a vesicular dermatomal rash, traditionally metameric. Old adults can present severe pain during the acute phase, and late complications, such as post-herpetic neuralgia that can trying and crippling. ⋯ Complementary therapeutic drug is often necessary. However, their application in old, frail, co-morbid and often poly-medicated patients have to be carefully considered as their use may be contraindicated. A specific vaccine is enable to reduce herpes zoster-related morbidity.
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The restless legs syndrome (RLS) is a frequent, often unrecognized disorder in the elderly. The diagnosis is essentially based on the clinical history. ⋯ The RLS is a chronic disorder with high impact on sleep and quality of life. Treatment is symptomatic and recommended drugs are dopaminergic agents, opioids, and gabapentine.
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Central venous catheterization is a frequently performed procedure in internal medicine units. Residents in training frequently share the same questions, doubts and fears about this procedure : "Should I perform a subclavian catheterization in a patient with mild thrombopenia?"; "Which site has the lesser complication rate?"; "After how long does a catheter need to be replaced?". This mini-review of the current literature tries to answer this and other questions.
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Thoracentesis is a procedure consisting in the insertion of a needle in the pleural space. It is used to remove and analyse pleural fluid. Based on a review of the literature, this article describes the indications, the contraindications, the complications and the technique of this commonly performed procedure.
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Diastolic heart failure is a frequent diagnosis, but now it is more acurate to call this heart failure with preserved ejection fraction. The diagnosis can be made non invasively by the echocardiography and measuring BNP (brain natriuretic peptide). ⋯ It is however certain that control of hypertension and heart rate are important. Fluid overload must also be treated with diuretics.