Swiss medical weekly
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The optimal approach to the treatment of cough consists, first, in determination of its precise cause. Treatment should be directed at the specific etiology or the pathophysiologic mechanism responsible for cough. The outcome of specific treatment is almost always successful. ⋯ In such cases symptomatic treatment with antitussives may be indicated. Centrally acting antitussives such as opium alkaloids, dextromethorphan and noscapine are the most effective drugs. The indication for expectorants lacks scientifically based support.
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Cough is a complex physiologic reflex which protects the lung from the inhalation of irritants and cleans the airways of excess secretions of solid particles. High linear velocities of flow in the airways are needed for the cough to be effective, and this depends upon the ability to achieve high expiratory flows and a reduction of airway caliber by dynamic compression. The efficacy of cough is compromised by a series of pathological conditions such as dysfunction of the cough reflex pathways, decrease in expiratory flows, abnormal dynamic compression, alterations in airway geometry, reduction in mucociliary clearance, and changes in bronchial secretions. Besides its protective action, cough may be responsible for adverse reactions or injuries.
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The purpose of investigating pulmonary gas exchange and pulmonary circulation is detection of functional abnormalities of the cardiorespiratory system. Other than clinical features, a number of specialized methods used today are of high accuracy and therefore serve to recognize early disorders and to quantify functional impairment. In clinical practice arterial blood gas analysis and the measurement of diffusing capacity are sensitive screening tests for patients with acute and chronic respiratory failure and thus have important diagnostic and therapeutic implications (e.g. indication for oxygen therapy, mechanical ventilation, chest physiotherapy, specific drug regimen etc.). Spiroergometry and right heart catheterization, as the more invasive methods, are useful tests in evaluating overall cardiopulmonary function to detect limiting factors in physical performance (e.g. thoracic surgery, occupational diseases, sport medicine).
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Sodium, urea, glucose and osmolality were determined in 50 hospitalized patients. Osmolality was calculated according to two different methods and compared with measured osmolality. ⋯ For the equation: blood ethanol concentration (g/L) = osmolal gap/27 we found a very good correlation between calculated and measured ethanol levels (r = 0.95). Our data confirm previous reports that blood ethanol can be quickly and fairly exactly estimated by using the osmolal gap.
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Swiss medical weekly · May 1988
[Savary's ulcer: a new complication of gastroesophageal reflux? Apropos of 32 endoscopically observed cases].
Savary's ulcer is a rare and little known peptic ulcer situated just above Barrett's esophagus. It is predominant in elderly women, bleeds less than Barrett's ulcer and is almost always associated with peptic stenosis. It is, like Barrett's and Wolf's ulcers, a complication of gastroesophageal reflux and not of Barrett's esophagus.