Schweizerische Rundschau für Medizin Praxis = Revue suisse de médecine Praxis
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The role of coronary artery disease in the epidemiology of congestive heart failure is important. In the pathophysiologic process of congestive heart failure, a number of adaptive mechanisms (hypertrophy, dilatation, neurohumoral stimulation) compensate for the decreased cardiac output by the failing heart. ⋯ Associated ventricular arrhythmias indicate a high incidence of sudden cardiac death. Recent considerations of clinical relevance are taken into account in tailoring treatment for patients with congestive heart failure.
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The heart of the elderly is characterized by increased occurrence of characteristic calcifications on mitral and aortic valves. These valves have been found calcified in persons older than 70 years at about equal frequency, in nearly 50% of these individuals simultaneously. A calcified mitral ring was more common in females of all age classes, aortic calcifications showed a less marked difference for gender. ⋯ Since coronary arteriosclerosis has a similar age distribution the risk for ischemic heart disease is increased. Early and particularly frequent calcifications of the aortic valve develop in patients with bicuspid valves. Risk for infective endocarditis is also raised by a factor of ten in patients with calcified aortic valve.
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Two types of irritant contact dermatitis are described: the acute and the cumulative toxic contact dermatitis. The acute contact dermatitis causes many different lesions on the skin. The most frequent irritants are acids and alkaline solutions. ⋯ Phototoxic reactions of the skin are not caused by immunologic factors, and they are only observed at sun-exposed areas. Drugs can cause frequently phototoxic reactions. The lesions on the UV-A-exposed skin are mainly erythema and blisters.
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In view of their potentially dangerous proarrhythmic effects, antiarrhythmic drugs should only be prescribed for patients with poorly tolerated symptomatic supraventricular arrhythmias. The choice of a suitable preparation depends not only on the type of arrhythmia, but also on the underlying heart disease and left-ventricular function. Digoxin, verapamil, sotalol and quinidine remain first-line drugs, while in view of recent trials the type-1c antiarrhythmics (flecainide) should only be given in cases resistant to other agents. Amiodarone is also an important and efficacious "reserve" antiarrhythmic, which has to be utilized at low doses to avoid its well-known side effects.
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Organ transplantation is increasing by becoming an important part of medicine and surgery. Its development is mainly restricted by a lack of organ donation. ⋯ Medical and paramedical professionals should be aware of the actual achievements in organ transplantation. Their motivation and their responsiveness should become the mainstays in the further development of transplantation.