Revue médicale de la Suisse romande
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Some nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides have been shown to modulate the immune and intestinal systems. They affect the synthesis of proteins and the expression of enzymes, as well as the activation and the proliferation of leukocytes and enterocytes. Since these immunonutrients modulate the response of tissues with rapid cell turnover, such as spleen, thymus, bone marrow and intestinal mucosa, they may also affect, such as suggested by some preliminary results, cancer cell proliferation and tumour growth. Therefore, further investigations are needed to understand the underlying mechanisms and to determine possible advantages and limitations of their administration to cancer patients.
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ECMO (extracorporeal membrane oxygenation) may be viewed as a prolonged cardiopulmonary bypass allowing for a prolonged cardio-respiratory support. Since its introduction in the 60's, its indication has expanded from acute respiratory failure to acute cardiac failure refractory to conventional treatments. The target group involves mainly those patients presenting with a cardiogenic shock following cardiac surgery or acute myocardial infarction. ⋯ However, its main limitation lies in its limited duration of 7 to 10 days, in particular because of hemorrhage complications. Currently, ECMO provides a temporary hemodynamical stability in order to perform an invasive cardiac treatment (coronary bypass or percutaneous dilatation), or to assess the eligibility of the patient for a long-term ventricular assist device, which will enable to wait for the availability of an allograft. The latter scenario is crucial nowadays because of the severe lack of organ donors, which is the leading cause of death among patients waiting for a heart transplant.
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Rev Med Suisse Romande · Dec 2001
[Dependence: all similar, all different. Point of view of a practitioner, point of view of a specialist].
Psycho-active substances dependent patients are similar in the mechanisms of addiction, but are individually very different and need a diversified approach. This paper is showing a general practitioner's point of view and the one of an addiction specialist regarding common clinical problems in such patients. The question of the treatment matching and of the level of care are discussed through an instrument for a rapid evaluation.