Revue médicale suisse
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The adequate treatment of fractures consists of a conservative or surgical approach whose goal is to assure a rapid solidity of the fracture site that will lead to a durable complete healing without complications. Fracture healing criteria remain controversial. In this article we are trying to present the tools used in the evaluation of bone consolidation and propose therapeutical guidelines aiming at the return to daily activities in full security.
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Revue médicale suisse · Dec 2008
Comparative Study[Lausanne Cohort of septic patients as an opportunity to develop multidisciplinary research within the Swiss Latin Network of Intensive Care Medicine].
Despite recent medical progresses in patient support, the mortality of sepsis remains high. Recently, new supporting strategies were proposed to improve outcome. ⋯ The Lausanne Cohort of septic patients aims at building a large clinical, biological and microbiological database that will be used as a multidisciplinary research platform to study the various pathogenic mechanisms of sepsis in collaboration with the various specialists. This could be an opportunity to strengthen the collaboration within the Swiss Latin network of Intensive Care Medicine.
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Revue médicale suisse · Dec 2008
Comparative Study[Physiopathologic aspects of microcirculation in intensive care].
In critical care patients, microvascular alterations and perfusion heterogeneity play an important role in the persistence of cellular hypoxia despite a satisfactory functioning of the macrocirculation. Advance in the knowledge of microcirculatory pathophysiology, and its relation with the macrocirculation could be in the future a way to improve the outcome of critically ill patients. Moreover, the evolution of clinical practice towards microcirculation monitoring as a standard of care, with new therapeutic targets aimed to increase tissue perfusion, could be a revolution in critical care practice.
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The authors express their views on the past, present and future of intensive care medicine in Switzerland. They point some past and present concerns in critical care medicine, but they insist on the future needs of this medical specialty: the critical patients necessitate, and have the right to obtain, a highly trained and specialized personnel, working in strong connection with the whole hospital, in a systemic way of treating patients. The authors insist on the very high complexity of the ICU-patients treated today.
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In critical care medicine, collaborative networks are well-developped for clinical research. This model is equally interesting for care, education and management. ⋯ Networks are very interesting for their members because they allows some small ICUs to survive and avoid very expensive costs related to restructuration of the larger ones. Thus, this model will certainly develop during the next years.