Swiss medical weekly
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The outcome of intensive care is related to patient selection and case-mix. Especially when assessing QOL, the results should be interpreted in the context of age and the cause of intensive care admission. Only a few QOL studies so far have databases which are large enough to characterize the outcome in specific patient groups. ⋯ While the QOL after intensive care as compared with reference values may be better perceived among older patients, the previously healthy and younger ones tend to experience more limitations. The reason for intensive care presumably has impact on the pattern of convalescence. A better understanding of the natural history of recovery from critical illness may help to identify those patients who need more intensive rehabilitation.
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Swiss medical weekly · Sep 1998
ReviewMyocardial dysfunction in sepsis: clinical and experimental investigations.
To review the clinical manifestations and mechanisms of cardiac dysfunction in septic shock. ⋯ Serious bacterial infections result in inflammatory injury to the heart manifested by a common profile of cardiac dysfunction. Therapy remains limited to treatment of the infection with antibiotics and supportive care, with fluid resuscitation and selective use of inotropes and vasopressors. Experimental models suggest that new anti-inflammatory strategies (e.g. tyrosine kinase inhibitors) may offer some advantages over those that target a single mediator; these agents remain to be clinically evaluated.
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Swiss medical weekly · Sep 1998
ReviewIntensive care for patients with medical complications of haematological malignancy: is it worth it?
Appropriately aggressive treatment of haematological malignancies can be complicated by a variety of life threatening events. Usually such acute events are, at least theoretically, potentially reversible and in view of the much improved prognosis of the underlying malignancy it is now generally considered to be appropriate to offer intensive care to selected cases, provided there is a reasonable prospect of cure or at least worthwhile palliation. A few remain concerned, however, and question whether the provision of intensive care for such patients is worthwhile. ⋯ BMT recipients have a particularly poor prognosis, especially when they require mechanical ventilation, and survival is unprecedented when ventilated BMT recipients either receive vasopressors or develop hepatic and renal insufficiency. It has not been possible to identify any features of the acute illness which influence the duration of long-term survival: this seems to depend solely on the progress of the underlying malignancy, something which is often difficult to predict before or during intensive care. In our view patients with life threatening complications of haematological malignancy should be offered intensive care unless or until it is clear that there is no prospect of recovery from the acute illness or that the underlying malignancy cannot be controlled.
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Swiss medical weekly · Sep 1998
[Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis].
Pylephlebitis, septic thrombosis of the portal vein and its branches, is an infrequent complication of intra-abdominal inflammatory processes which may lead to thrombosis of the portal vein or to liver abscesses. Air in the protal venous system usually predicts a fatal outcome. The survival rate calculated in all reported cases is less than 25%. ⋯ Pylephlebitis used to be a dreaded complication of appendicitis, but the incidence of this disease has greatly declined since the development of antibiotics and modern surgical techniques. We present two cases of pylephlebitis associated with gas in the portal vein as a result of left colonic diverticulitis treated by bowel resection. In spite of the occurrence of portal venous gas, the outcome may be favourable if this disease undergoes prompt surgical treatment.