Swiss medical weekly
-
Swiss medical weekly · Jan 1985
[Immunologic laboratory tests in acquired immunodeficiency syndrome (AIDS) and suspected AIDS].
Since AIDS-specific laboratory tests are not yet commercially available, laboratory diagnoses of AIDS or of the AIDS-related complex (ARC) are based on "surrogate markers". While single tests are of limited diagnostic value, test combinations are of greater help. However, these tests should be applied restrictively and stepwise. ⋯ A discrimination index of 100 means that a given test is pathologic in all members of one group and negative in all members of the other group. A discrimination index of 60 may mean 80% of pathological values in one group versus 20% in the other. To distinguish AIDS patients from ARC patients the test combination yielding the highest mean discrimination index included serum neopterin, complement factor B and C-reactive protein.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Swiss medical weekly · Jan 1985
[Residual lung function changes following adult respiratory distress syndrome (ARDS) in children].
Residual lung function abnormalities have been investigated in 9 children (4 boys and 5 girls) a mean 2.7 years after surviving severe adult respiratory distress syndrome (ARDS). All patients had been artificially ventilated for an average of 9.4 days with a FiO2 greater than 0.5 for 34 hours and maximal PEEP levels in the range of 8-20 cm H2O. ⋯ In all patients abnormal lung functions were found, i.e. ventilation inequalities (8), hypoxemia (7), and obstructive (2) and restrictive (1) lung disease. A significant correlation between respirator therapy and residual lung function was found (duration of FiO2 greater than 0.5 in hours and inspiratory plateau pressure during respirator therapy vs. ventilation inequalities and hypoxemia).
-
Swiss medical weekly · Jan 1985
Case Reports[Deep accidental hypothermia without cardiorespiratory arrest].
A case is reported of profound accidental hypothermia with spontaneous cardiac activity in a patient presenting several risk factors. The rewarming from 23.5 degrees C to 36.5 degrees C by partial cardio-pulmonary bypass was carried out without complications and in particular without cardiac arrythmia. As far as we are aware this is the twelfth case of profound accidental hypothermia reported in the literature in which rewarming was carried out by this method and the fourth case not involving cardiac arrest. Rapid rewarming by partial cardio-pulmonary bypass could be useful in patients with profound accidental hypothermia without cardiac arrest, the most serious complication being, precisely, cardiac arrest during rewarming.
-
Incidence and type of de novo tumours were studied retrospectively in 187 consecutive patients who had received kidney transplants between 1967 and 1981 and undergone immunosuppressive therapy for 2 months or longer. Up to the end of June 1983, 18 patients (9.6%) had developed 22 malignancies and 7 of them had died from the tumour. The risk of developing a malignancy appeared to increase with prolonged immunosuppression. ⋯ The risk of developing any malignancy appeared to be some 20 times that in the general population. The practical management of patients with de novo tumours is described in the light of our own patient material and the recent literature. Finally, two further oncological problems are discussed: first, the incidental grafting of malignant cells with the transplant, and second, how to proceed in a transplant candidate with a previous malignancy.
-
Only in the last century was the narcoleptic syndrome recognized as a distinct entity fundamentally different from epilepsy. It is characterized by increased daytime sleepiness, usually as short sleep attacks, and by cataplexy. The latter is reflected in attacks of fully or incompletely developed loss of muscle tone, and in distressing akinetic states (so-called sleep paralysis) which chiefly occur in transition states between wake and sleep. ⋯ Many narcoleptics suffer from hallucinations, which may occur as they are falling asleep, during sleep paralysis, cataplectic attacks, and daytime sleepiness. Knowledge of the pathogenesis of narcoleptic disturbances is still incomplete but has been essentially widened by the discovery of paradoxical sleep, because cataplexy, sleep paralysis and hypnagogic hallucinations may now be interpreted as dissociated paradoxical sleep phenomena. The treatment of narcolepsy comprises advice in appropriate daily regimen, nutrition and vocational orientation as well as medication by stimulating agents for hypersomnolence and by tricyclic drugs for cataplexy.