Revue médicale de Bruxelles
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Congenital anomalies of the thoracic veins are infrequent but important developmental disorders. Anomalies of the systemic thoracic veins usually are asymptomatic but may be associated with other more serious cardiovascular abnormalities and complicate their management. We present a case of a vertical vein consisting in an abnormal venous drainage from the left upper pulmonary lobe to the superior vena cava, resulting in a non cyanotic shunt.
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Asthma and COPD are common problems seen by general practitioners. They share several signs and symptoms, so that a differential diagnosis generally needs lung function testing, with at least a spirometry, either performed on several occasions, or completed by bronchodilation or non specific bronchoprovocation tests. Spirometry should become one of the tools used daily by a general practitioner.
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A good knowledge of clinical presentation and of risk factors for pulmonary embolism is mandatory to improve adequate clinical suspicion. Some recent improvements in diagnostic strategy have to be emphasized. A low D-dimer level has a good negative predictive value to rule out pulmonary embolism. ⋯ In case of non diagnostic scan, serial non invasive search for deep vein thrombosis in the limbs is recommended by some experts at least in patients with good cardio-respiratory reserve, pulmonary angiography being recommended otherwise. Spiral CT allows direct demonstration of clots, being hardly less sensitive than pulmonary angiography except for subsegmental emboli. Future perspectives include the use of spiral CT as first choice procedure, as well as magnetic resonance imaging.
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For more than 25 years, quantitative approaches were applied to evaluate the outcome of diagnostic and therapeutic strategies. Decision analysis is but one quantitative approach that guides therapeutic decisions. ⋯ It uses a model represented by a decision tree that helps the clinician tot quantify the outcomes. Followed by sensitivity analysis, it may provide a robust basis for the final decision.