Swiss medical weekly
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Swiss medical weekly · Apr 1987
[Whiplash trauma of the cervical vertebrae in traffic: biomechanical and expert-opinion aspects].
The indirect injury mechanisms of the cervical spine should be subdivided into "non-contact injury" of the cervical spine, without head impact, by definition (hyperflexion or hyperextension), sometimes also called whiplash injury mechanism, and bending mechanism due to head contact, i.e. "contact injury" (hyperflexion, hyperextension, lateral bending, axial compression). The term "whiplash" is, in strict biomechanical terms, very often incorrect since it implies a biphasic motion (hyperextension and hyperflexion, or vice versa); in traffic collisions, however, its second phase is insignificant. The terms used for the injuries themselves should be taken from the classic morphology (fracture, luxation, distorsion etc.). ⋯ In the latter case the patient should not be treated as a malingerer. Moreover, if more than two vehicles are involved the reconstruction of the accident is greatly facilitated if the lesion can be proven to be a "contact" or "non-contact" injury (legal implications, insurance payments). The (rare) severe cervical spine injuries in seat belt wearers are not caused by the restraining effect of the belt but by bending and injuring of the neck due to head contact which often is not completely avoidable (justification of mandatory seat belt law).
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Hemofiltration has been advocated for reduction of extravascular lung water (EVLW) in both clinical and experimental ARDS. The influence of hemofiltration on EVLW was studied retrospectively in 10 patients with this syndrome. After 2 to 38 hours' hemofiltration net fluid balance was -3640 +/- 3609 ml. ⋯ In 4 patients a reduction of over 15% in EVLW was achieved, whereas in the remaining 6 patients EVLW changed within a range of +/- 10%. However, hemofiltration caused a decrease in cardiac output and oxygen delivery, thereby adversely affecting its benefits on EVLW and gas exchange. In ARDS hemofiltration should be performed under careful hemodynamic monitoring and only in some of the patients an immediate reduction in EVLW can be achieved.
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From the historical viewpoint, a change of attitude towards pain and the possibilities opened up by general anesthesia from 1846 onwards were needed to bring about the advent of a surgery specialized in the cure of pain. The individual stages in this development, up to Leriche's "Chirurgie de la douleur", are illustrated by reference to the relevant sources.
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Swiss medical weekly · Oct 1986
Case Reports[Hb Q-H: study of in vitro globin chain synthesis in reticulocytes and erythroblasts].
The case is reported of a 24-year-old Chinese patient with congenital hemolytic anemia (Hb 95 g/l, MCV 71 fl, MCHC 29 g%, reticulocytes 165% RBC). Clinical examination revealed jaundice and marked splenomegaly. ⋯ In vitro globin chain synthesis in reticulocytes and erythroblasts indicates that this variant is localized in an alpha-thal-2 chromosome. Furthermore, this variant does not exhibit any transcriptional defect of the alpha Q gene or any instability, since its association with a second alpha-thal-1 chromosome leads to a deficit of alpha chain production identical to that observed in Hb H disease (alpha alpha 0/alpha 0 alpha 0).
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Swiss medical weekly · Sep 1986
Randomized Controlled Trial Comparative Study Clinical Trial[Premedication in fiber optic bronchoscopy from the patient's and the physician's viewpoint--a randomized study for the comparison of midazolam and hydrocodone].
To evaluate side effects and patients' assessment of fiberoptic bronchoscopy under local anesthesia, 122 consecutive patients answered questions from an outside interviewer (an experienced psychiatrist) and not from the endoscopists themselves. The effect of premedication with midazolam (5 mg i.m.) and hydrocodonum (15 mg i.m.) was compared in a randomized study. In a multiple choice questionnaire 68% of all patients indicated considerable fear in the days before bronchoscopy. ⋯ Although they did not remember all the unpleasant side effects, only 77% said they would repeat the procedure with the same premedication, compared with 90% of patients premedicated with hydrocodonum (p = 0.08). Before and two hours after premedication the reaction times had not changed (optical sign, Wiener reaction device) and were identical in the two patient groups. At that time 37% of the patients premedicated with midazolam and 27% of those premedicated with hydrocodonum were still sleepy and could not be regarded as fit for any form of travel.