Revue médicale suisse
-
Revue médicale suisse · Jun 2010
[Pre-operative cardiac assessment in non-cardiac surgery: a frequent dilemma simplified by a decision tree].
In patients undergoing non-cardiac surgery, cardiac events are the most common cause of perioperative morbidity and mortality. It is often difficult to choose adequate cardiologic examinations before surgery. ⋯ The role of coronary angiography and prophylactic revascularization will also be discussed. Finally, we provide a decision tree which will be helpful to both general practitioners and specialists.
-
Revue médicale suisse · Jun 2010
[Preoperative cardiac assessment before non-cardiac surgery: cardiac risk stratification].
Perioperative cardiac events occurring in patients undergoing non-cardiac surgery are a common cause of morbidity and mortality. Current guidelines recommend an individualized approach to preoperative cardiac risk stratification prior to non-cardiac surgery, integrating risk factors both for the patient (active cardiac conditions, clinical risk factors, functional capacity) and for the planned surgery. Preoperative cardiac investigations are currently limited to high-risk patients in whom they may contribute to modify the perioperative management. A multidisciplinary approach to such patients, integrating the general practitioner, is recommended in order to define an individualized peri-operative strategy.
-
Revue médicale suisse · May 2010
[Skin diseases in returning travelers: etiologies according to clinical presentation].
Dermatoses are one of the three most common causes of health problem in returning travelers. These dermatoses include infections, environmental diseases (sunburns, arthropod-related reactions) and superficial injuries. ⋯ Travelers abroad must be appropriately vaccinated against tetanus and specifically instructed to avoid arthropods bites and sun overexposure. Travel first aid kits should include antibiotics effective against bacterial skin infection, oral antihistamines and corticosteroid ointments.
-
In some patients with refractory epilepsy, no resective surgery of the epileptogenic zone can be offered. This is the case when for instance the epileptogenic zone is located in an eloquent region (motor, language or visual) or when there are several epileptogenic zones. ⋯ Among these procedures, we review briefly here vagus nerve stimulation, the various brain stimulations procedures, multiples subpial transsections, and the corpus callosotomy. For each procedure, we will discuss its indication and outcome.
-
Epilepsy surgery is possible in specific cases of localisation-related pharmaco-resistant epilepsy and can often lead to seizure-freedom condition. A presurgical diagnostic workup is necessary to localise the epileptic focus and assess the risks of post-operative neurological or cognitive deficits. ⋯ All patients suffering from pharmaco-resistant epilepsy should be referred to an expert centre to confirm the diagnosis and evaluate the possibility of epilepsy surgery. In children, early epilepsy surgery can allow better continuation of cognitive development and education.