Revue médicale suisse
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Septic shock is a frequent admission cause in intensive care unit. In spite of the important progresses in the understanding of his physiopathology, mortality due to septic shock is about 20%. Recently, it has been demonstrated that an early goal-directed therapy permitted to improve the patient prognosis. With a good hemodynamic management and early antibiotherapy, mortality could be reduced.
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Revue médicale suisse · Apr 2005
Review[Sarcoidosis: new therapeutic and pathogenic aspects for an "old" disease].
Sarcoidosis is a multisystemic disorder of unknown etiology characterized by non-caseating epithelioid granuloma. Clinical features are protean and the lack of a specific diagnostic test can make diagnosis difficult. ⋯ Recent progress, especially in immunology and molecular biology, has advanced our understanding of the pathogenesis of the disease and improved our ability to diagnose and treat this complex condition. This article gives an overview about current concepts in sarcoidosis and focus on immunopathogenic and therapeutic aspects.
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Revue médicale suisse · Mar 2005
Review[Utility of procalcitonin for the diagnosis and the follow-up of infections in febrile neutropenic patients].
Procalcitonin is a marker of severe bacterial infections in non-neutropenic patients. The goal of this review is to assess its utility in the management of neutropenic patients. ⋯ Present knowledge suggests that procalcitonin may contribute to identify patients in whom 1) antibiotics could be stopped in the absence of bacterial infection, 2) investigations and adjustments of the antimicrobial therapy for persistent fever are needed. The use of procalcitonin for the management of febrile neutropenic patients should be studied prospectively.
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In febrile children and adults, it is frequently difficult, based on the sole clinical examination, to differentiate a bacterial illness from systemic inflammatory syndromes or severe viral infections. However, the positive and rapid diagnosis of a severe bacterial infection or a sepsis is essential to initiate lifesaving therapies. ⋯ Plasma levels below 0.5 microg/l usually rule out a severe bacterial disease, whereas values above 2 microg/l are strongly indicative of a bacterial sepsis. The usefulness and the limitations of the measurement of procalcitonin as a diagnostic and a prognostic tool during severe bacterial infections are discussed in this paper.