Revue médicale suisse
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Brachytherapy, the placement of an encapsuled radioactive source (Iridium) in or near a tumor, is a palliative therapeutic modality available for patients suffering of a bronchogenic cancer, especially if they present invalidating symptoms such an incoercible cough, haemoptysis, dyspnea. The treatment modality is indicated if chemotherapy or external irradiation are not possible. It is typically a team work.
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We report a case of combined pulmonary fibrosis and emphysema. This syndrome, including upper-lobe emphysema and pulmonary fibrosis of the lower lung was recently described in smokers or ex-smokers (mean age: 65 years). Exertional dyspnea is always present. ⋯ High resolution CT-scan is key of diagnosis with upper lobes emphysema with diffuse infiltrating fibrosing disease at the bases. Pulmonary hypertension is present is almost 50% of patients, representing the principal negative pronostic factor. Five years survival is 54.6% (median survival 6, 1 years).
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A subgroup of obese subjects which could be protected from the cardiometabolic complications of obesity is described in the literature as "metabolically normal obese subjects". However, the lack of a joint definition of metabolic normality makes the available data difficult to interpret and to compare. ⋯ The obese subjects who remained metabolically normal showed, at three years, significantly higher values of cardiometabolic parameters as compared to subjects with normal body weight. In conclusion, the obese subjects even without any metabolic abnormality should benefit of a closer medical monitoring as well as a regular follow-up to avoid further weight gain.
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Medical errors result in 44,000 to 98,000 deaths per year in the United States of America. Within the surgical specialties, half of these errors occur in the operating room. The origin of these errors is multifactorial, and is generally associated with problems in communication and teamwork. ⋯ This approach favors a better utilization of surgical checklists, improves efficiency during chirurgical interventions, and reduces patient mortality. In October 2009 we introduced a CRM course within the department of surgery at the Geneva University Hospitals. We are presenting this program as well as the first results following its application.