Revue médicale de Bruxelles
-
Dementia and depression are among the most frequent and disabling conditions in the elderly. The prognosis of depression is similar in young and elderly patients; however, treatment can be more risky in the latter. Incorrect diagnosis of dementia as well as therapeutic relentlessness should be avoided. ⋯ Patients with very mild dementia are often referred for a depression, which is ruled out by careful examination. There is no simple mean to differentiate dementia from depression. The proper way remains to perform a strict clinical, neuropsychological and psychiatric examination.
-
Delirium or acute confusional state is a common neuropsychiatric syndrome in later life. Failure to recognise delirium and treat the underlying organic condition may have fatal consequences. In delirium the main aspects of cognition, thinking, perception and memory are all disordered to some degree. ⋯ Its onset is acute and its duration is brief (less than one month). Typically, the severity of the symptoms fluctuates during the daytime with peaks at night. The adequate treatment of delirium presupposes that the syndrome has been diagnosed and that its underlying causes have been identified.
-
Lower respiratory tract infections--croup, tracheo-bronchitis, bronchiolitis and pneumonia--represent one of the major causes of pediatric consultation. They occur most frequently during the first years of life, are usually not recurrent and require hospitalization in less than 2% of the cases. They are associated in time with epidemics of respiratory virus and Mycoplasma pneumoniae infections, but the role of bacteria as primary infectious agents, or as causes of superinfection is significant.
-
Bicarbonate administration during lactic acidosis seems logical in view of the myocardial depression associated with the decrease in intracellular pH. This treatment has been recently challenged on the basis of observations showing an increase in the veno-arterial gradient for CO2 during acute circulatory failure. The partial transformation of bicarbonate in CO2 carries the risk of aggravating the phenomenon and thereby decreasing intracellular pH. Alternatives to sodium bicarbonate--carbicarb, THAM and dichloroacetate--are discussed.