Swiss medical weekly
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Cardiac contusion is frequently seen after blunt chest trauma; it is often missed, and can cause serious complications. The incidence, features and outcome of cardiac contusion are described.
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Mortality in blunt hepatic trauma is still high, death being most frequently caused by hemorrhage. Associated injuries are present in nearly all cases. A variety of possible surgical procedures allow treatment tailored to fit the individual situation. Even the sophisticated intensive care required by the frequent posttraumatic complications is not a substitute for adequate surgery.
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In developed countries tuberculosis has not yet been eradicated and diagnostic problems still remain. The purpose of this study was to analyze the clinical pattern, epidemiological data and risk factors in 85 patients (59 males and 26 females, mean age 41 +/- 15 years) seen from 1975-1984 in the medical outpatient clinic of Basle with the diagnosis of tuberculosis. The organ distribution of the tuberculosis was as following: lung n = 54, cervical lymph nodes n = 9, pleura n = 7, peritoneum n = 3, endometrium n = 2, bones n = 2, pericardium n = 1, middle ear n = 1, urinary tract n = 1, skin n = 1, cerebrum n = 1, miliary tuberculosis n = 3. ⋯ Histological examination was the most appropriate procedure in tuberculosis of lymph nodes and peritoneum. In all patients treatment was as follows: isoniacid (INH), rifampicin and ethambutol for the first 4 months, followed by isoniacid and ethambutol for 6-10 months. In summary, tuberculosis has no typical clinical pattern and biochemical tests are unhelpful in establishing diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Three patients aged 52, 22 and 29 years, without known previous heart disease, sustained acute myocardial infarction due to blunt chest trauma. A 52-year-old man without a history of heart disease sustained an acute non-transmural lateral myocardial infarction following blunt chest trauma during a sledging party. No coronary arteriography was performed. ⋯ No sign of preexisting atherosclerotic coronary disease was found. A 29-year-old man admitted to the hospital after blunt chest trauma during a football game developed an acute transmural inferior infarction with an uncomplicated clinical course. Seven months later coronary arteriography demonstrated a 40% obstructive lesion of the right coronary artery, compatible with thrombosis and subsequent recanalization.
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Diabetes mellitus is a heterogeneous syndrome. Insulin-dependent type 1 diabetes is characterized by progressive deterioration of B-cells in the islets of Langerhans resulting in a fall in insulin secretion. According to recent studies, autoimmune mechanisms are the reason for the B-cell destruction. ⋯ Fasting plasma insulin levels are normal or increased; fasting C-peptide concentrations may be used to distinguish this type of diabetes from type 1 diabetes. Plasma fasting C-peptide concentrations less than 300 pmol/l usually indicate type 1 diabetes and levels above 300 pmol/l type 2 diabetes. Classification of diabetics according to pathogenesis is important, since different therapeutic and preventive measures are necessary.