[Schwartz-Bartter syndrome during intermittent acute porphyria].
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Biomedical subjects
Publications and source records attributed to A Cornil.
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Pulmonary embolism, a major complication of thromboembolic disease, remains an important cause of mortality, both in surgical and medical practice. In recent literature, one finds two different currents: the first one asserts that pulmonary embolism is overdiagnosed and, therefore, "overtreated" with iatrogenic hemorrhagic complications, when other authors assert that pulmonary embolism is underdiagnosed and "undertreated". It is obvious that clinical diagnosis of non massive, acute pulmonary embolism remains difficult and that the classical triad pleuritic chest pain, hemoptysis and signs of deep venous thrombosis is not frequently found. The clinician should be attentive to the different symptoms and clinical signs which might arouse a suspicion of pulmonary embolism. A large range of investigations is available to confirm the clinical diagnosis. In deep venous thrombosis preceding or accompanying pulmonary embolism, treatment should be instituted at the first signs of venous attack. A precise diagnosis will secondarily be confirmed by phlebography. Any delay in effective early treatment of thromboembolic disease will increase the risk of pulmonary embolism and of the mortality inherent in this dreadful complication.
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During a five year period 36 episodes of septicaemia in 32 patients with hepatic cirrhosis were documented. This represents 20% of the patients hospitalized with a decompensated cirrhosis and 1.1% of the patients with non decompensated cirrhosis. In patients with decompensated cirrhosis, enteric Gram-negative organisms were most frequently isolated (91% of the cases) and ascitis was infected in one third of the cases. No primary foci of infection were documented. On the contrary patients with a non decompensated cirrhosis had infection mostly with Gram-positive organisms (82%) and foci of infection (skin, throat) were documented in 38% of the cases. Infection by enteric organisms was associated with higher mortality than infection by non enteric organisms (68% vs 28%). Five patients with inappropriate antibiotic treatment died from septic shock. Spontaneous septicaemia and peritonitis are frequent complications if cirrhosis. There are potentially treatable causes of deterioration in the cirrhotic patient, necessitating prompt recognition and treatment.
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