Revue médicale suisse
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Revue médicale suisse · May 2009
[Pulmonary rehabilitation: a multidisciplinary and comprehensive intervention].
Pulmonary rehabilitation is an evidence-based, multidisciplinary and comprehensive intervention for chronic pulmonary diseases, adressed to symptomatic patients and to patients with impairment of activities of daily life. The major outcomes of this intervention are an increased exercise capacity, a decrease in dyspnea and thereby a better quality of life. Underweight patients may benefit from a caloric and protein supplementation. Smoking cessation programs should be integrated in any pulmonary rehabilitation program.
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Revue médicale suisse · May 2009
[Bronchopleural fistula: a serious complication after thoracic surgery].
Postsurgical bronchopleural fistula (BPF) is a serious complication accompanied with a high mortality, requiring early and correct diagnosis. The acute form of BPF is usually a technical failure of the surgical stump requiring an immediate surgical reoperation. The subacute or chronic BPF is more difficult to diagnose because of non specific symptoms. It requires well targeted antibiotics depending on microbiology, an adequate drainage of the thoracic cavity and very often repeated surgical or endoscopic procedures.
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Suspicion of viral encephalitis should always be considered as a medical emergency and the prognosis depend on both the immune status of the host and the virulence of the virus. Among them, the herpes simplex virus is by far the most important one since it can be associated with severe encephalitis in immunocompetent host, and because a good response to acyclovir can be expected when rapidly initiated. ⋯ In addition, other germs than viruses can mimic viral encephalitis and must be taken into consideration. The purpose of this review is to update the investigation that should be performed in clinical practice for any patient with suspicion of acute viral encephalitis.
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Hardware removal should be decided only after careful examination of the medical and economic implications. Current literature fails to offer systematic guidelines. Infected hardware, non-union after surgery or obvious mechanical problems are straightforward indications for implant removal. ⋯ Protection against toxicity, allergy, carcinogenesis or possible implant failure should not prompt systematic removal. Hardware removal in children should be considered separately, since metallic implants can interfere with normal growth patterns. Overall, implant removal should not be considered a routine procedure, and indications for surgery should reflect the thorough examination of the risks and the benefits.