[Exercise-induced laryngeal obstruction†: diagnosis and management]. / Obstruction laryngée induite à l'effort: méthodes diagnostiques et prise en charge.

Exercise-induced laryngeal obstruction (EILO) is a condition characterized by temporary narrowing or closure of the larynx during physical activity, in particular during intense physical exertion. It generally affects teenagers and young adults and is often misdiagnosed as exercise-induced asthma. Symptoms include dyspnea, wheezing and a feeling of throat tightness during exercise. The aim of this article is to review this often underrecognized condition, its diagnosis and its management.

L'obstruction laryngée induite à l'effort (EILO) est une affection caractérisée par le rétrécissement ou la fermeture temporaire du larynx au cours d'une activité physique, en particulier lors d'un effort physique intense. Elle touche généralement les adolescents et les jeunes adultes et est souvent diagnostiquée à tort comme de l'asthme d'effort. Les symptômes comprennent une dyspnée, une respiration sifflante et une sensation d'oppression au niveau de la gorge pendant l'exercice. Cet article passe en revue cette pathologie souvent méconnue, son diagnostic et sa prise en charge.

Lithium-induced ECG modifications: navigating from acute coronary syndrome to Brugada syndrome.

Lithium is frequently used in the treatment of bipolar disorders and is known to induce ECG alterations. This case study describes various patterns of lithium-induced ECG modifications in a patient with acute-on-chronic lithium intoxication. Clinicians should be familiar with this problem as it can have life-threatening consequences and lead to important changes in patient's management. Our patient was admitted for acute delirium with an ECG showing atrial fibrillation with wide QRS and ST-segment elevation. These modifications were first mistaken for an acute myocardial infarction and a diagnosis of Brugada syndrome was finally reached. Treatment after the acute phase implied changes in the therapeutic modality and required frequent monitoring.

Emergency department visits for non-life-threatening conditions: evolution over 13 years in a Swiss urban teaching hospital.

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients' characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p=0.128). Of these patients, 54.0% vs 57.0% were male (p=0.329), 55.5% vs 58.7% were Swiss (p=0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p<0.001); 57.7% vs., 58.3% consulted during out-of- hours (p=0.821). Trauma-related visits decreased from 34.2% to 23.7% (p<0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p<0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP's treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p<0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.