Revue médicale suisse
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Acute kidney injury is common in critical illness and associated with important morbidity and mortality. Continuous renal replacement therapy (CRRT) enables physicians to safely and efficiently control associated metabolic and fluid balance disorders. ⋯ The choice of the substitution fluid depends on the clinical situation. A dose of 25 ml/kg/h is currently recommended.
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Enhanced Recovery After Surgery (ERAS) is a multimodal concept combining pre, intra and postoperative evidence-based care elements to reduce surgical stress. ERAS pathways have been shown to significantly reduce morbidity, length of hospital stay and total costs when applied to colorectal surgery. ⋯ However, uncritical application of the guidelines issued from colonic procedures seems inappropriate as the surgical procedures in pelvic cancer surgery differ considerably. This article reports on the first steps of an ERAS project and his introduction in urology.
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Revue médicale suisse · Nov 2013
[Granulomatous lymphocytic interstitial lung disease in common variable immunodeficiency].
Common variable immunodeficiency (CVID) is the most frequent primary immune deficiency. Recurrent infections are classical consequences of CVID, but their impact has been largely reduced by immunoglobulin replacement. ⋯ GLILD currently constitutes an important cause of morbidity and mortality in these patients. It is distinct from bronchiectasis secondary to recurrent infections, and presents similarities but also striking differences with sarcoidosis.
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Obstructive sleep apnea (OSA) tends to worsen on the supine posture due to the effect of gravity on tongue position. In some cases, OSA is present exclusively on the supine posture (exclusive postural OSA). These patients may benefit from positional therapy (PT), which aim is to prevent sleep in the supine posture using different types of devices. ⋯ Because the efficacy of PT is inferior to continuous positive airway pressure (CPAP), the latter treatment remains the first line of therapy. Also, the discomfort of the existing devices appears to limit the long term use of PT. Further studies assessing the long term effects of PT on metabolic and neurocognitive outcomes are needed.
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Revue médicale suisse · Nov 2013
[Neutrophil gelatinase-associated lipocalin as a new diagnostic tool for acute kidney injury].
Diagnosing acute kidney injury (AKI) may be a challenging situation in the daily practice. Generally, only serum creatinine has been used as a biomarker. ⋯ Recent discovery of neutrophil gelatinase-associated lipocalin (NGAL) as structural marker heralds an important step in diagnostic of AKI. The early diagnostic of AKI made possible with detection of urinary or plasmatic NGAL allows early appropriate intervention, which is crucial to short and long-term clinical outcome.