Swiss medical weekly
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Swiss medical weekly · Dec 1988
[Intensified insulin therapy in Type 1 diabetes. Results of a 1-year treatment using the basic-bolus principle in hard-to-control diabetic patients].
Thirty-six adult type 1 diabetics, whose metabolic control was unsatisfactory on conventional insulin treatment or on continuous subcutaneous insulin infusion, were treated for an average of 13 months by the basis-bolus insulin regimen using pen-like insulin injectors. HbAlc-values improved from 8.1% before to 6.7% at the end of the observation period, with the same daily injected amount of insulin (39 +/- 2 IU/d before, 38.7 +/- 2 IU/d after switching to the new regimen). The number of hypoglycemic events did not increase with the new insulin regimen. ⋯ Some patients were bothered by the need for intensified self-monitoring of blood glucose. The insulin regimen according to the basis-bolus principle using pen-like injectors led to an improvement of both metabolic control of the patients and their quality of life. It is, however, mandatory that they are properly instructed and willing to perform regular home monitoring of blood glucose.
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Swiss medical weekly · Nov 1988
Randomized Controlled Trial Clinical Trial[Systemic thrombolysis using streptokinase. Experiences at the Civic Hospital of Lugano in the framework of the ISIS-2 study].
With a small group of Swiss hospitals we had an opportunity of participating in ISIS-2, the major study on thrombolysis in acute myocardial infarction. Experience with our microcosm (Ospedale Civico Lugano) was compared with the macrocosm of the results of ISIS-2 in 17,187 randomized patients (in brackets). ⋯ In the ISIS-2 study the combination of thrombolytic therapy with streptokinase, and of antiplatelet therapy with aspirin, showed a reduction of approximately one third in acute mortality of myocardial infarction, stroke and reinfarction. Our experience confirms the reduced incidence of allergic side effects (3.5%), major bleeding (0.3%) and minor bleeding (2.9%) during or after thrombolytic therapy.
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Swiss medical weekly · Oct 1988
Case Reports[Paraplegia following pneumonectomy. An anesthesiological or a surgical complication?].
A case of postoperative paraplegia after pneumonectomy of the left lung is presented. The patient received thoracic epidural anaesthesia for postoperative pain relief. ⋯ The neurological sequelae were caused when the arterial blood supply to the spinal cord was compromised during surgery. However, to rule out epidural hematoma in such patients, a CAT scan of the spine must be performed immediately.
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Swiss medical weekly · Sep 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Is there a risk of global respiratory insufficiency with the use of intramuscular midazolam as premedication for bronchoscopy?].
To determine whether midazolam i.m. as premedication for bronchoscopy involves a risk of overall respiratory failure, we compared hydrocodonum (15 mg i.m.) with midazolam (5-7.5 mg i.m., weight related) as premedication in flexible bronchoscopy in two groups of 30 patients. The two groups were comparable. Arterial blood gases were measured before premedication, before bronchoscopy, and 10 and 60 minutes after the procedure. ⋯ Side effects were rare and similar. Confusional states, as reported with midazolam given orally, were not noted. Midazolam administered as reported above is of value as premedication in flexible bronchoscopy.
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Swiss medical weekly · Aug 1988
Case Reports[Soft-tissue cervicofacial emphysema and pneumomediastinum caused by self injury].
A prison inmate was referred to us for diagnostic procedures and therapy due to a combination of pneumomediastinum with emphysema of neck and face. External injuries were absent and pathogenesis remained uncertain until thorough examination of the patient revealed two intraoral wounds, presumably from a needle, reaching into the maxillary sinus. This large subcutaneous emphysema of the face, neck and mediastinum was the result of an exaggerated Valsalva maneuver. With this self-inflicted injury, unknown to us, the prisoner achieved the desired immediate admission to hospital.