Swiss medical weekly
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Swiss medical weekly · Jun 1992
[Single cusp homograft implantation in the reconstruction of right ventricular outflow tract in the correction of tetralogy of Fallot].
From 1987 to 1990, 37 children underwent surgical correction for tetralogy of Fallot. The mean age was 38.2 months (2-156 months). The indication for right ventricular outflow tract (RVOT) obstruction in 19/37 (51%) children was: hypoplastic pulmonary valve (n = 10), annular hypoplasia (n = 12), RVOT obstruction and hypoplastic pulmonary artery (n = 10). ⋯ Echocardiography revealed residual pulmonary regurgitation in 4 children, pulmonary stenosis in 6 and combined residual pulmonary valve defect in 6. If severe malformation of the RVOT or the pulmonary artery is present, a valved homograft is recommended for repair of tetralogy of Fallot. Good morphological and functional results may be achieved.
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Transthoracic echocardiography is an easily accessible, non-invasive imaging procedure for evaluation and follow-up of critically ill patients. It is particularly helpful in evaluating patients with thoracic pain, low-output syndrome or heart murmur, and has prognostic value in acute myocardial infarction. It makes a diagnostic contribution in 60 to 90% of cases, and has therapeutic implications in 50 to 65%. New ultrasound technics are briefly discussed.
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Cerebral malaria is the most important manifestation of severe Plasmodium falciparum infection. The clinical picture in South East Asian adults differs from that in African children. The children are more likely to have abnormal brain stem reflexes, signs suggestive of cerebral herniation, and raised CSF opening pressure, and to suffer persistent neurological sequelae. ⋯ The pathophysiology of cerebral malaria may involve mechanical obstruction of the cerebral circulation by parasitized erythrocytes which have adhered to the vascular endothelium. Cytokines such as tumor necrosis factor may also contribute. The most important element of treatment is early, optimal chemotherapy with quinine, but artemisinine derivatives may prove even more effective.
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Recent developments in the pathophysiology and treatment of sepsis have clearly shown the confusion produced by the imprecise terminology used to define the various facets of the sepsis process. The criteria required to diagnose bacteremia, sepsis, sepsis syndrome or septic shock vary from one author to the other. This inaccuracy accounts for the inability to compare the results of therapeutic investigation from different groups. The aim of this article is to point out the necessity of standardized terminology and to propose definitions which might be appropriate.
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Septic shock is an acute impairment of tissue perfusion, characterized by hypotension, low systemic vascular resistance and increased blood levels of lactate. Myocardial dysfunction is common despite hyperdynamic circulation, and may limit the patient's ability to respond to increased tissue oxygen demand. ⋯ The disproportionately high splanchnic oxygen demand in sepsis makes the splanchnic region susceptible to tissue hypoxia, which may contribute to the development of multiple organ failure in septic shock. Since the changes in regional oxygen transport do not necessarily parallel changes in systemic oxygen transport, the effects of vasoactive drugs on regional blood flow in sepsis should be studied in more detail.