Swiss medical weekly
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Only in the last century was the narcoleptic syndrome recognized as a distinct entity fundamentally different from epilepsy. It is characterized by increased daytime sleepiness, usually as short sleep attacks, and by cataplexy. The latter is reflected in attacks of fully or incompletely developed loss of muscle tone, and in distressing akinetic states (so-called sleep paralysis) which chiefly occur in transition states between wake and sleep. ⋯ Many narcoleptics suffer from hallucinations, which may occur as they are falling asleep, during sleep paralysis, cataplectic attacks, and daytime sleepiness. Knowledge of the pathogenesis of narcoleptic disturbances is still incomplete but has been essentially widened by the discovery of paradoxical sleep, because cataplexy, sleep paralysis and hypnagogic hallucinations may now be interpreted as dissociated paradoxical sleep phenomena. The treatment of narcolepsy comprises advice in appropriate daily regimen, nutrition and vocational orientation as well as medication by stimulating agents for hypersomnolence and by tricyclic drugs for cataplexy.
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The various pathological types of aneurysm are reviewed and their natural history discussed in relation to morphology, etiology and site of the aneurysm. For diagnostic purposes, computed tomography is a reliable method in the detection of aortic aneurysm; for evaluation of the ascending segment, ultrasonography may also be considered a useful procedure. The two non-invasive methods are particularly valuable in monitoring patients with thoracic aneurysms not (yet) suitable for surgery. ⋯ Angiography may be mandatory only for those few presurgical candidates who require accurate assessment of aortic valvular regurgitation and determination of peripheral organ perfusion. The extremely unfavourable natural history of acute aortic dissection (50% survival after 48 hours following onset of symptoms) clearly calls for immediate operative treatment in high-risk patients, that is in subjects with acute ascending aortic dissection (hospital mortality 28% in our series). The better prognosis of descending aortic dissection suggests that in these cases conservative hypotensive therapy is the treatment of choice; surgical intervention in type B acute dissection is indicated only if occlusion of a major aortic branch occurs or if impending rupture of the dissecting hematoma becomes evident.(ABSTRACT TRUNCATED AT 400 WORDS)