Revue médicale suisse
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Revue médicale suisse · Nov 2006
Review[Autologous blood pre-donation and perioperative use of erythropoietin].
The general concept of blood saving covers a number of technical and pharmacological actions which all aim to maintain the erythrocyte mass of the patient, and of which blood transfusion is only one. Severe anemia (Hb <60-80 g/l) increases postoperative mortality and morbidity. However, its correction by blood transfusion tends to worsen the prognosis. ⋯ Detecting anemia is of primary importance. Whenever possible, its cause should be identified and treated. Depending on the detected anemia, as well as the blood loss expected during surgery, the patient should receive EPO (anemia with foreseeable moderate blood loss), or autologous pre-donation associated with EPO (anemia with foreseeable large blood loss).
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Revue médicale suisse · Nov 2006
Review[Hemorrhage and transfusion: the case of Jehovah's witnesses].
For Jehovah Witness patients the additional responsibilities of surgeon, anesthetist and intensivist represent a particular challenge. A "therapeutic" contract needs to be established at the very outset specifying the commitment and undertaking of each party. ⋯ Above all, the entire medical team must respect the personal values of the patient despite any contradiction with their own values. This means that judgements based on values must be avoided in order to allow for the freedom of thought.
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In the past, red blood cells were given in case of acute anemia, the decision being often based on the hemoglobin concentration alone. The clinical situation and the comorbidities of the patient as well as the secondary were given only a little, if any, consideration. Presently, the evidence shows that red blood cells transfusion has to be individualized in every single patient, taking into consideration the risks of the transfusion, the coexisting medical problems and the patient's tolerance to acute anemia. Experimental and clinical research confirms that a much lower hemoglobin concentration can be tolerated than previously admitted if normovolemia is preserved, the most important transfusion trigger being a sign of insufficient oxygen consumption and signs of an inadequate circulation.
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Revue médicale suisse · Nov 2006
Review[Dyspnea: is medical history still useful for its evaluation?].
Dyspnea is a common symptom and a major cause of medical consultation. Fast and reliable diagnostic work-up warrants minimization of the risks, sometimes vital, incurred by the patient. ⋯ Verbal expressions used by dyspneic patients have been analyzed and progressively linked to given pathophysiological situations. Becoming more fluent with the language of dyspnea would allow physicians to break down any communication barriers and provide the best care possible to patients with dyspnea.
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In Switzerland, environmental tobacco smoke (ETS) is widespread and affects 25% of the never smokers. The risk of having lung carcinoma is increased by 23% for never smokers who report exposure to ETS, and women are particularly at risk. ⋯ In children, however, there is increased incidence of asthma when the mother (+36%) or both parents (+50%) are smokers. All-cause mortality (+ 15%) and disease-specific mortality for lung cancer (+65% to + 79%) are increased among ETS exposed never-smokers.