Revue médicale suisse
-
Revue médicale suisse · Jan 2009
[Pneumology. Should we fear inhaled anticholinergic bronchodilators?].
In 2008, studies on inhaled anticholinergic bronchodilators for chronic obstructive pulmonary disease (COPD) were published, some of them with contradictory messages. One study, and a meta-analysis suggested that inhaled ipratropium on the long- term is associated with increased risk for cardiac death. ⋯ On the other hand, a large randomized, placebo-controlled study on tiotropium did not suggested increased adverse cardio-vascular effects, but rather a diminution, and showed beneficial bronchodilator effect in patients with COPD. However the treatment did not attenuate the annual decline of lung function, and did not decrease mortality in these patients.
-
The emergency medicine appears more and more as a transversal discipline, leaning on specific competences regularly updated with evidence-based medicine concepts. This selection of recent articles presents an update on frequent conditions, including the place of neuroimaging for patients with seizures or minor head injuries, the management of acute cocaine intoxications, the diagnosis of aortic dissections, or the management of cardiopulmonary arrest. The primary care physician will find elements of diagnostic or therapeutic strategies. This selection reflects the dynamism of emergency medicine.
-
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.
-
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.
-
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.