Revue médicale de Bruxelles
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Myocardial infarction remains a major healthcare problem. Reperfusion therapy has been shown to influence favourably short- and long-term patient survival. ⋯ Primary PCI often remains the treatment of choice. A national policy is still required to implement the guidelines and improve clinical practice for our STEMI patients.
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The authors describe in this article the possible complications of spine surgery. By exposing them, they wish to draw the attention of the practitioners on the multiple risks related to these operations, as well as the means to prevent them and to make them stop their effects. ⋯ Up to the present day, a fault must be proven in the management of a medical case. A reminder of the foundations of the medical responsibility applied to the surgery of the spine is reported, knowing well that surgical damages are not always the result of an error or a misconduct, and therefore, the surgeon is not responsible for the damage in the absence of a proven fault.
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Comparative Study
[Impact of the mode of arrival in the emergency department for patients with a STEMI and the clinical outcomes in terms of ejection fraction and survival].
Emergency Medical Services (EMSs) play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates patient outcome according to his mode of arrival in the care unit dealing with acute coronary syndromes. ⋯ Among 136 patients, 56.6 % arrived by EMS and 43.4 % by their own means. Patients who arrived by EMS were older (p = 0.008) and had a higher Killip score (p < 0.05). Pain-to-Angiography and Door-to-Angiography intervals were shorter in patients who arrived by EMS (222 vs 416 mins, p < 0.0001 and 62.6 vs 147 mins, p < 0.0001, respectively). There were no differences in the left ventricular ejection fraction (LVEF) and survival. However, for patients suffering an IVA attack, survival to six months and one year was better in the EMS group (88.9% vs 78.3%, p < 0.05 and 80.5 % vs 69.6 %, p = 0.05). In conclusion, dealing with STEMI infarctions is quicker by EMS admission. The infarctions admitted by this way are more serious. Wherever STEMI infarctions were localised, no improvement of LV function and survival was observed according to the mode of arrival, contrary to the subgroup with an IVA attack where survival is better at six months and one year by EMS admission.
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Case Reports
[Cervical necrotizing fasciitis arising from dental abscess: a rare clinical observation].
Necrotizing fasciitis of the head and neck is a rare polymicrobial infection, rapidly progressing with a potentially fatal outcome, without early recognition and treatment. Odontogenic infection spreading to the lower neck or anterior chest is an important clinical feature. CT-scan and MRI can be useful in case of doubt. ⋯ Antibiotherapy is based on the organisms most frequently involved. Hyperbaric oxygen therapy and vacuum-assisted closure could have a role after initiation of intravenous antibiotics and surgical debridement. We report a case of a 23-year old man with a necrotizing fasciitis from a dental origin, necessitating an extensive and repeated surgery, a tracheotomy and antibiotherapy; he developed severe complications such as multisystem organ failure, pericardial effusion and cardiorespiratory arrest.
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The initial management of Parkinson's disease and is adaptation is presented. Levodopa remains the most efficacious treatment of the disease. However, with the long term, the efficacity of the drug is slowing down and secondary effects are frequent. ⋯ If the patient is younger than 65 years, we would usually start therapy with a dopamine agonist because of the lower risk of motor complications. Levodopa is a potent alternative and can be given if there is an inadequate response to the agonist. When motor complications are present, some options are usefull like the administration of dopaminergic agonists or apomorphine, the utilisation of inhibitors of the dopamine catabolism, the deep brain stimulation and the jejunal administration of dopa.