Swiss medical weekly
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Swiss medical weekly · Jul 1990
[Liver transplantation. Preliminary results in the district University Hospital of Geneva].
Between July 1987 and May 1989, 11 liver transplants were performed on 10 patients at the University Hospital of Geneva. Of 15 patients evaluated for elective transplantation, 10 were accepted and put on the waiting list. 5 patients were rejected because of a contraindication or because another treatment seemed preferable. 8 transplantations were eventually performed. Emergency transplantation was considered for 6 patients, but could be performed in only 3. ⋯ Earlier evaluation of patients would make transplantation feasible soon after the first complication of the disease. This attitude would probably prevent patients from dying while on a waiting list and decrease operative as well as early postoperative risks. Better information and coordination regarding potential donors is necessary in Switzerland to obtain better results in organ transplantation.
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After ingestion of seven leaves of oleander (Nerium oleander) in a suicide attempt, a 37-year-old woman was admitted to hospital with symptoms of digitalis intoxication. The serum digoxin level on arrival was 5.69 nmol/l. The course was uneventful. The usefulness of digoxin radioimmunoassay to demonstrate poisoning with oleander (but not to predict the degree of toxicity) and the potential use of digoxin-specific Fab-antibody fragments in this situation are discussed.
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Swiss medical weekly · Mar 1990
Review Case Reports[Severe hemolytic anemia following purse-string valvuloplasty of the mitral valve].
A patient who had undergone valvuloplasty for mitral insufficiency due to chordal rupture developed severe hemolytic anemia a few weeks after surgery. Progressive mitral regurgitation was noted at the same time. ⋯ Fourteen months later mitral valve replacement (St Jude) was performed and the hemolysis ceased promptly. A brief review of the literature is presented.
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Quality medical care during transport of critically ill pediatric and neonatal patients is only possible if the referring hospital and the regional center cooperate closely. The experience of physicians and nurses involved is of great importance, and the choice of the transporting team should depend on the medical status of the patient and the skills of the physicians and nurses or paramedics. Critically ill children and neonates should be transported by specialized teams. Our statistics from the last 12 years show an increasing number of transports, with the majority of patients being referred from peripheral hospitals.
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Swiss medical weekly · Feb 1990
[Weaning using continuous-flow CPAP: hemodynamics and gas exchange].
The present study was designed to investigate hemodynamics and gas exchange during weaning from mechanical ventilation (assist/control mode) to spontaneous breathing with continuous high flow (chf)-CPAP, and to study the predictive value of these parameters in respect of longterm success or failure of weaning. Hemodynamic and gas exchange parameters were obtained in 10 patients without severe pulmonary and cerebral dysfunction at -240, -60, -30, and -15 min before, and at +15, +30, +45, +60, +120, +180, +240 min after chf-CPAP. During chf-CPAP significant increases in heart rate/min (92 +/- 17 to 103 +/- 20), cardiac index (3.9 +/- 0.7 to 4.4 +/- 1.0 1/min.m2), respiratory rate/min (15 +/- 1 to 28 +/- 7), PaCO2 (36.7 +/- 3.0 to 41.2 +/- 5.9 torr) and oxygen delivery (12.2 +/- 2.7 to 13.9 +/- 2.3 ml/min.kg) were found. ⋯ In the 4 patients who required mechanical ventilation 12 to 34 hours after the end of the study we found a significantly more pronounced increase in heart rate than in those who where weaned successfully (114 +/- 19 vs 89 +/- 9). Increases in heart rate, respiratory rate, cardiac index, PaCO2 and oxygen delivery can therefore be expected during weaning from mechanical ventilation to spontaneous breathing with CPAP. A pronounced increase in heart rate may suggest a weaning failure.