Swiss medical weekly
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Swiss medical weekly · Jun 1986
Case Reports[Antibiotic-resistant Corynebacteria--a new problem of infection in immunosuppressed patients].
Corynebacterium species can normally be found on the skin and mucous membranes but rarely cause infections. They are sensitive to most antibiotics. Two patients with severe aplastic anemia undergoing antilymphocyte globulin therapy developed septicemia with a highly antibiotic-resistant corynebacterium (JK-group) only sensitive to vancomycin. ⋯ One patient was even colonized with corynebacterium for several months before. If this strain is detected in the blood when new fever develops during prolonged neutropenia and broad-spectrum antibiotic therapy, it indicates serious infection in these highly compromised patients. Both cases illustrate that regular microbial surveillance can help to reveal colonization of high risk patients with multiple antibiotic-resistant corynebacterium strains and thus allow early initiation of treatment with vancomycin, which is the only effective antibiotic.
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Swiss medical weekly · Jun 1986
Comparative Study Clinical Trial Controlled Clinical Trial[Cyclosporin A and hyperlipidemia after kidney transplantation. Prospective study].
Hyperlipidemia is common after renal transplantation and has been attributed, at least in part, to corticosteroid therapy. We therefore studied serum lipids in a group of nondiabetic transplant recipients on conventional immunosuppression with azathioprin and prednisone (Aza/P), in comparison with a transplanted group on cyclosporin A monotherapy (CyA) without steroids. ⋯ Atherogenic hypercholesteremia was found as frequently in patients on CyA as in those on Aza/P. Possible factors preventing normalization are discussed.
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Swiss medical weekly · May 1986
[Transcranial Doppler sonography. A new method for the diagnosis of cerebrovascular diseases].
Transcranial Doppler sonography, a new method for the evaluation of cerebrovascular disease, is presented. After outlining the technical basis, investigation technique and normal values, the authors describe the utility of the method for the evaluation of stenosis and occlusions of the extracranial and intracranial arteries, spasms after aneurysmatic subarachnoid hemorrhage, arteriovenous malformations, and patients with arrested cerebral circulation due to high intracranial pressure. The value of Doppler methods for the evaluation of cerebrovascular diseases is discussed.
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Swiss medical weekly · Apr 1986
[Work of breathing in spontaneous respiration with continuous positive airway pressure].
In postoperative respiratory failure continuous positive airway pressure (CPAP), besides improving pulmonary gas exchange, influences respiratory mechanics. Elastic and flowresistive components of respiratory work were measured in intensive care patients being weaned from the respirator. Measured values during breathing with a continuous-flow CPAP system with elastic reservoir were compared with those for O2 breathing via T-tube. ⋯ Compliance, tidal volume and respiratory frequency did not change significantly. The reduction in respiratory work was primarily due to decreased nonelastic work associated with a decrease in resistance. Thus, on weaning from mechanical ventilation using a reservoir-CPAP system, the respiratory work was reduced in comparison to O2 breathing via T-tube.
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Swiss medical weekly · Apr 1986
[The effect of positive end-expiratory pressure (PEEP) on extravascular lung water in intensive care patients].
The use of positive end-expiratory pressure (PEEP) has been highly recommended because of its favourable effects on pulmonary gas exchange and circulation. It was the aim of this study to investigate the influence of PEEP on extravascular lung water (EVLW), which was estimated by the thermal-dye technique. In 12 intensive care patients PEEP was changed every 30 minutes from 0 to 5, 10, 15 and 0 cm H2O, thereby causing a non-significant increase in EVLW of 2, 10, 7 and 1%. ⋯ Therefore, shorttime application of PEEP did not affect EVLW. Patients with normal EVLW were more prone to show increased EVLW during PEEP than patients with elevated EVLW. PEEP-induced improvement of gas exchange and pulmonary shunt were not accompanied by changes in EVLW.