Swiss medical weekly
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To reduce the very high mortality rate due to septic shock, a new clinical entity has been defined: sepsis syndrome. The aggressive treatment of any sepsis syndrome should prevent the evolution towards a state of shock and thus reduce the risk of a fatal outcome. ⋯ Several pharmacological or immunological interventions--antagonists directed at mediators and multiple cytokines involved in the pathogenesis and perpetuation of sepsis syndrome and septic shock--have been successful experimentally. However, new therapies, such as those using monoclonal antibodies against endotoxins of TNF, cannot yet be considered established.
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The author discusses factors promoting the occurrence of acute mountain sickness and high altitude pulmonary edema. The level of altitude as well as the speed of ascent are important determinants and can be influenced by behaviour. ⋯ The importance of an exaggerated hypoxic pulmonary vascular response for the pathogenesis of high altitude pulmonary edema is demonstrated by the observation that this illness can be treated or prevented by lowering pulmonary artery pressure with nifedipine. In most cases, however, acute mountain sickness and high altitude pulmonary edema can be prevented without the help of drugs, by adjusting the speed of ascent to the degree of susceptibility to these illnesses.
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Malignancy is the leading cause of exudative pleural effusion in patients over 60. Several techniques for palliative treatment of malignant pleural effusions (MPE) are recommended; in particular, sclerosing agents have been instilled into the pleural cavity. In up to 30%, recurrence of MPE cannot be prevented. ⋯ After a review of the most frequent techniques of pleurodesis, a treatment strategy, mentioning the indications for the thoracoscopic procedure, is presented stressing the following guidelines: after complete thoracocentesis the patient's respiratory symptoms should decrease significantly and the compressed lung must be expanded clinically and radiologically after drainage. For patients fulfilling these conditions thoracoscopic pleurodesis is an effective initial treatment. It seems to be a safe procedure with minor side effects even for patients in a reduced general condition.
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Swiss medical weekly · Feb 1992
Case Reports[Severe accidental hypothermia with cardiopulmonary arrest: prolonged resuscitation without extracorporeal circulation].
We describe a case of severe hypothermia in a 32-year-old patient who fell into a crevasse. Three hours later he was rescued and flown to a district hospital. On arrival he was apparently dead, with cadaveric skin, dilated and fixed pupils, pulseless and in respiratory arrest. ⋯ Further, uninterrupted external cardiac compression guarantees efficient circulation even over several hours. Electric defibrillation in a hypothermic patient is ineffective unless normal body temperature has been reached. Lastly, every effort to continue resuscitation must be made in the still hypothermic patient whose absence of clinical response may obscure the real possibility of complete recovery.
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In cases with a history of swallow syncope, an ECG should immediately be taken during ingestion of solid or liquid food in order to determine the rhythm disturbances responsible for the syncopes. Both esophageal passage and cardiac diagnosis are indicated, since, as shown in the literature, pathologic findings are not uncommon. The triad syncope, bradyarrhythmia while swallowing is considered to be an indication for definitive electrostimulation (pacemaker implantation) unless, exceptionally, halting digitalis medication puts an end to the syncopes.