Swiss medical weekly
-
The various pathological types of aneurysm are reviewed and their natural history discussed in relation to morphology, etiology and site of the aneurysm. For diagnostic purposes, computed tomography is a reliable method in the detection of aortic aneurysm; for evaluation of the ascending segment, ultrasonography may also be considered a useful procedure. The two non-invasive methods are particularly valuable in monitoring patients with thoracic aneurysms not (yet) suitable for surgery. ⋯ Angiography may be mandatory only for those few presurgical candidates who require accurate assessment of aortic valvular regurgitation and determination of peripheral organ perfusion. The extremely unfavourable natural history of acute aortic dissection (50% survival after 48 hours following onset of symptoms) clearly calls for immediate operative treatment in high-risk patients, that is in subjects with acute ascending aortic dissection (hospital mortality 28% in our series). The better prognosis of descending aortic dissection suggests that in these cases conservative hypotensive therapy is the treatment of choice; surgical intervention in type B acute dissection is indicated only if occlusion of a major aortic branch occurs or if impending rupture of the dissecting hematoma becomes evident.(ABSTRACT TRUNCATED AT 400 WORDS)
-
The hyperlipidemias, with hypertension, diabetes mellitus and cigarette smoking, are amongst the major risk factors for the development of atheroma. The inter-relationships of hyperlipidemia and atheroma are complex but both appear to have a strong inherited component. Amongst the multiple genetic factors determining the common forms of hyperlipidemia, the apolipoprotein genes coding for the major peptides of the plasma lipoproteins (chylomicrons, VLDL, LDL and HDL) may be of particular relevance since the latter form a system of inter-converting particles for the delivery of lipid (triglyceride and cholesterol) to peripheral tissues (including the arterial wall). ⋯ Another DNA polymorphism that generates a new SstI site was shown to be present at low frequency (8%) in a random sample of the population. However, its frequency increased dramatically (42%) in a group of hypertriglyceridemic patients. It is thus not inconceivable that further studies of the genes involved in lipid metabolism will eventually help to replace the present phenotype based classification of lipid metabolism disorders by a genotype based system.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Swiss medical weekly · Aug 1984
Comparative Study Clinical Trial Controlled Clinical Trial[Criteria for hemostasis in kidney transplant patients. Comparison of patients undergoing immunosuppression with cyclosporin and azathioprine steroids].
Studies on one-year function conducted by the European Multicenter Trial showed that, after renal allograft transplantation, bleeding complications were only found in patients treated with cyclosporin as compared with those treated with azathioprin/steroids. To investigate a possible relationship between the bleeding tendency and the cyclosporin treatment, 18 parameters of hemostasis were studied in 11 patients, 6 of whom received cyclosporin A and the other 5 conventional treatment with azathioprin/steroids. Bleeding tendency could not be related to any specific coagulation parameter. ⋯ All factor-VIII related activities were elevated in both groups. The main difference between the cyclosporin group and the conventionally treated group was significantly elevated levels of factor VIII procoagulant antigen (VIII: CAg) (cyclosporin A treated group: VIII: CAg 435 +/- 145%, conventionally treated group: VIII: CAg 215 +/- 99%). These results suggest hypercoagulability rather than bleeding tendency under cyclosporin treatment.
-
Swiss medical weekly · Jul 1984
Case Reports[Acute rhabdomyolysis following administration of succinylcholine].
Acute rhabdomyolysis without hyperthermia, after anesthesia including succinylcholine, is described in a father and son. Rhabdomyolysis-associated acute renal failure was mild in the son but severe in the father. Known enzymatic muscular defects were excluded as cause. The clinical picture of anesthesia-associated rhabdomyolysis is discussed on the basis of these two cases and a review of the literature.