Swiss medical weekly
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The functional anatomy of the cervical spine, the biomechanics of lesions due to rear end collisions, the human behaviour of victims of these collisions and the influence of insurance, legislation, court decisions and the modalities and duration of treatment are discussed in a survey of the literature on lesions of the cervical spine due to rear end collisions. The problems posed by changed court rulings on lesions of the cervical spine due to rear end collisions are mentioned, as well as the danger of producing a "whiplash" compensation epidemic. ⋯ The prevention of lesions of the cervical spine and head due to rear end collisions will only be possible if car safety engineers succeed in preventing rear end collisions and/or in ending hyperextension by appropriate devices. The head supports in use today are not sufficient to prevent hyperextension of the cervical spine.
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Swiss medical weekly · Apr 1993
Case Reports[Unstable spinal injuries in cranio-cerebral injuries].
Estimates of the incidence of injury to the cervical spine among patients suffering blunt trauma to the head vary widely. In an attempt to quantify the risk, the records of 593 consecutive patients with blunt craniocerebral injuries admitted to our trauma center in 1991 were reviewed. ⋯ In the management of head trauma with associated cervical spine injuries realignment and immobilization of the spine and surgery of the head were carried out as first step, followed by decompression and stabilization of the affected segment in the same session. In patients with altered consciousness there is always loss of cooperation and early spinal stabilization for optimal treatment in the intensive care unit and in the wake-up-phase is important.
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Considerable evidence has accumulated indicating that the chest radiograph is the most reliable imaging technique to evaluate the severity of lung edema in patients with established ARDS. Recently, the radiographic approach has been validated by direct comparison of an x-ray score of edema with the densitometric analysis of lung CT scan images. CT scanning may prove useful in quantitating the amount of residual healthy lung and in evaluating the effectiveness of PEEP in patients with acute respiratory failure. ⋯ A number of radioisotopic techniques have been developed, based on the evaluation of the leakiness of the alveolar-capillary barrier either from the vascular or from the airspace side. Clearance of aerosolized DTPA from airspaces, although extremely sensitive, is not specific for ARDS in as much as factors other than lung injury may equally affect the rate of DTPA clearance from the lung. External detection of transvascular protein flux may serve as noninvasive means to assess the integrity of the lung microvascular endothelial barrier.(ABSTRACT TRUNCATED AT 250 WORDS)
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During septic shock, cytokines produced by host cells play an important role in the pathogenesis of hemodynamic involvement and cellular lesions. Recently, natural inhibitory substances able to neutralize the biological activity of tumor necrosis factor alpha (TNF alpha) and interleukin-1 (IL-1) were described. These inhibitory molecules are involved in the regulation of the production of these cytokines. ⋯ IL-1 ra improved the outcome in some experimental diseases (endotoxemic shock, cerebral malaria arthritis, graft-versus-host reaction). The treatment of septic shock with IL-1 ra is currently being assessed in phase I and II clinical studies. Blockade of cytokines by antibodies or naturally occurring inhibitory molecules could lead to new therapies for septic shock.
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Swiss medical weekly · Mar 1993
Case Reports[Laryngospasm: unusual manifestation of celiac disease].
Gluten-induced enteropathy or coeliac disease is a condition characterized by malabsorption and a variety of clinical manifestations. In adults, coeliac disease may be discovered while investigating iron-deficient anemia, bone pain or unexplained weight loss. ⋯ The malabsorption syndrome was responsible for low levels of vitamin D, causing the electrolytic imbalance. Laryngospasm is a rare symptom of hypocalcemia and has not, to our knowledge, been described in the context of coeliac disease.