Revue médicale suisse
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Revue médicale suisse · May 2009
Case Reports[Bochdalek hernia: a rare cause of dyspnea and abdominal pain in adults].
We present here a case of a sixty year old man with a symptomatic hernia of Bochdalek. Its diagnostic was long to be established because this type of congenital diaphragmatic hernia is rare and mainly occurs in neonates. However when looking at a patient with dyspnea and lasting atypical abdominal pain, such a diagnosis has to be looked for, even if such a clinical entity is extremely rare in adults.
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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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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.