Revue médicale suisse
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Neurology is a polymorphic discipline, with several subspecialties. In 2006, as in the previous years, a huge amount of scientific work focusing on treatment has been published. ⋯ This allows to consider more and more variables when administering a specific treatment, therefore, in each subspecialty a move towards a better patient's care has been made. In this contribution, several specialists analyse and interpret new facts about their respective neurological domain.
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Revue médicale suisse · Dec 2006
Review[Tight glucose control in the ICU: how aggressive should we be?].
The issue of tight glucose control in intensive care remains controversial. Compelling evidence supports the use of intensive insulin therapy in postoperative patients, particularly those who have undergone cardiac surgery. ⋯ These data suggest that the optimal target for blood glucose needs to be better defined in critical care practice and might depend on the underlying pathology. Therefore, while awaiting the results of multi-centric studies, including a large heterogeneous cohort, a less aggressive approach for glucose control is preferable in the majority of critically ill patients.
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Revue médicale suisse · Dec 2006
Review[What about quality of life in elderly intensive care survivors?].
Elderly patients are more and more frequent in intensive care units (ICU). Few studies focused on the ouality of life (QOL) of those patients after ICU. QOL refers to the subjective perception of the health status by the patient himself. ⋯ Elderly patients have usually a reduced functional status compared to the general population, or compared to younger ICU patients. QOL of these patients seems to be comparable to the QOL before ICU admission, especially in the psychological and mental domains, but it is sometimes reduced in the physical domains. Those results seem to be explained by a better acceptance by the elderly of their physical difficulties.
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Revue médicale suisse · Nov 2006
Review[Autologous blood pre-donation and perioperative use of erythropoietin].
The general concept of blood saving covers a number of technical and pharmacological actions which all aim to maintain the erythrocyte mass of the patient, and of which blood transfusion is only one. Severe anemia (Hb <60-80 g/l) increases postoperative mortality and morbidity. However, its correction by blood transfusion tends to worsen the prognosis. ⋯ Detecting anemia is of primary importance. Whenever possible, its cause should be identified and treated. Depending on the detected anemia, as well as the blood loss expected during surgery, the patient should receive EPO (anemia with foreseeable moderate blood loss), or autologous pre-donation associated with EPO (anemia with foreseeable large blood loss).