Revue médicale suisse
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Revue médicale suisse · May 2006
Review[Radiofrequency ablation in ventricular tachycardia: an alternative to implanted cardioverter defibrillator?].
Patients with ventricular tachycardia (VT) are subject to frequent recurrences despite antiarrhythmic drug therapy. Radiofrequency ablation is a useful alternative. Implantable defibrillators terminate episodes of VT but do not prevent them. ⋯ There are two situations: VT in patients without identifiable structural heart disease or idiopathic VT and VT related to structural heart disease. After catheter ablation, idiopathic VT has a good prognosis and implantable defibrillators are usually not indicated. Scar-related VT are more difficult to treat with catheter ablation, but this technique is particularly useful for controlling frequent defibrillator shocks and incessant VT.
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Severe sepsis and septic shock are frequent pathologies accounting for approximately 11% of all admissions in intensive care units (ICU). In the United States, between 1979 and 2000 the incidence of sepsis increased by 8,7% annually and septic shock) remains the second most frequent cause of death in non-coronary ICU. Although our understanding of the host defense mechanisms against infections and of the pathogenesis of septic shock have progressed during the last decade, these progresses have not yet yielded the anticipated advantages. Recent new therapeutic approaches, especially early-goal directed therapy, activated protein C (drotrecogin alpha activated), moderate doses of corticosteroids and intensive insulin therapy have given encouraging results.
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Revue médicale suisse · Mar 2006
[Generic drug prescribing: pilot study on the impact of the new drug pricing system on costs and potential savings].
The impact of a systematic generic substitution and of the new drug pricing system (implemented in 2002 for cost saving reasons) on prescription cost was computed on the basis of prescriptions delivered in January 1999 for patients leaving our university hospital. A total of 3,099 prescriptions, representing 5,514 drugs, were delivered in one month, of which 335 (6%) were excluded (drug not available in 2002 or magistral preparations). Forced generic prescription would have saved 3,8% of global costs, while the new drug pricing system would have increased costs between 1,1% and 8,0%. In this specific setting, savings linked with forced generic drug prescription was weak (4 to 5%), and the expected savings of the new drug pricing system were not observed.