Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis
-
Transplantation of the liver has progressed in recent years and has become universally accepted for numerous indications in end-stage liver diseases, predominantly primary biliary cirrhosis, sclerosing cholangitis, biliary atresia and liver-related metabolic disorders. In fulminant and subfulminant hepatitis, prognosis has been improved considerably by liver transplantation. ⋯ The risk of tumor recurrence after transplantation for small hepatocellular carcinoma in cirrhosis can be calculated; adjuvant chemotherapy might increase prognosis. Transplantation for other malignant liver tumors seems to be obsolete.
-
Schweiz. Rundsch. Med. Prax. · Aug 1994
Case Reports[Jejunum perforation following blunt abdominal trauma--a case report].
We describe an intestinal perforation in a football player who had been hit with the knee in the abdomen. Perforation of the small bowel, following blunt abdominal trauma, is relatively rare. Its most frequent cause is a deceleration trauma, usually from a traffic accident. ⋯ This rate is adversely affected by concomitant lesions in other organs and by delay (more than 10 h.) in diagnosis. When laparotomy has been delayed and peritonitis is present, antibiotic treatment should be started immediately during surgical intervention (cephalosporin, aminoglycoside, metronidazole). Postoperative complications include septicaemia, wound infection and, rarely, enterocutaneous fistulae.
-
Schweiz. Rundsch. Med. Prax. · Jun 1994
[Risk assessment and patient information before anesthesia].
In order to determine the risk of anesthesia the anesthesiologist has to assess both the physical and the psychological status of the patient. The essential basis of any preoperative medical evaluation are the history and complete physical examination of the patient. Few laboratory screening tests and, in case of pathological findings, specific diagnostic procedures will ensue. ⋯ He also informs the patient about the planned anesthesia, the sequence of further measures, the risk of anesthesia, and accompanying risks. The family doctor can help to facilitate the preoperative assessment by performing certain examinations himself and by providing the anesthesiologist with relevant informations. By giving a piece of advice to the patient he can help to prepare him for anesthesia and to reduce fear and apprehensiveness.
-
The term "Necrotizing soft tissue infections" describes a group of limb- and sometimes lifethreatening infections mostly of the limbs. The necrotizing soft tissue infections are classified, depending on the involved tissue level, microbiology and clinical course: 1. primarily located in the subcutaneous level and fascia: 1.1 hemolytic streptococcal gangrene, 1.2 necrotizing fasciitis, 1.3 gram-negative, synergistic, necrotizing cellulitis, 1.4 clostridial cellulitis, 1.5 anaerobic nonclostridial-cellulitis; 2. primary located in the muscle: 2.1 clostridial myonecrosis, 2.2 streptococcal myositis. Between 1989 and 1992 17 patients with necrotizing soft tissue infections were treated at the Department of Surgery, University Hospital of Zurich. ⋯ The surgical treatment has to be aggressive with extensive debridement of the affected areas supported by intensive care. Delayed or even omitted surgical treatment, inappropriate therapeutic concepts and incomplete debridement with compromises may have fatal consequences. Repeated debridement as well as amputation of the affected limb is justified to guarantee the patient's survival.
-
Schweiz. Rundsch. Med. Prax. · Apr 1994
Case Reports[Chronic spondylogenic pain syndrome--tb-spondylitis?].
The incidence of tuberculosis is increasing in many of the industrialized countries, mainly due to the spreading of HIV infections, the migration from countries with high prevalence of tuberculosis and possibly through the increase of the aged population. In 10 to 25% of the cases, tuberculosis manifests itself in extrapulmonary organs. One of the most frequent locations is the spine. ⋯ In patients belonging to a risk group or with known exposition to tuberculosis and vertebral pain, the TB spondylitis must be included in the differential diagnosis. Combined chemotherapy is the key to successful therapy and can make surgical interventions or immobilization unnecessary. Two cases are presented, and the disease of the TB spondylitis is discussed.