Swiss medical weekly
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Swiss medical weekly · Jun 1984
Biography Historical ArticleAlpha 1-antitrypsin deficiency: some personal experiences.
A short review is given on the discovery of the alpha 1-antitrypsin deficiency, a hereditary metabolic defect, in 1963, its biochemical identification, the recognition of its typical clinical manifestations and effects on lung physiology. Several genetic variants are mentioned. The gradual development of the concept of proteolytic digestion of lung elastin by excess of leucocyte elastase as a basic phenomenon in the pathogenesis of emphysema is discussed in some detail.
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Hypertensive emergencies are defined as situations where a seriously elevated blood pressure threatens the patients life or vital organ functions. Since treatment of hypertensive emergencies by a rapid reduction of blood pressure can be complicated by serious unwanted effects, the treatment indications should be defined cautiously. In addition the principles of autoregulation of blood flow and vascular resistance in hypertensive patients should be considered as well as the widely differing effects of the drugs used in hypertensive emergencies like alpha- and beta-adrenergic blocking substances, central sympatholytics and vasodilating agents. ⋯ In many instances calcium-antagonists can be considered as drugs of first choice since they lower blood pressure in relation to pretreatment blood pressure and have only a weak negative inotropic effect. In addition they exert their vasodilating action predominantly in vessels with a high vasoconstrictor tone and do not reduce cerebral perfusion despite a marked reduction of blood pressure within a short time. In every case the initial emergency treatment should be followed by a careful long term management of hypertension.
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A resuscitation team has been organized in the CHUV for the purpose of immediate intervention on the scene of cardiac arrest or any other life-threatening condition. The team composition is as follows: 1 anesthesiologist, 1 internist (usually cardiologist) and 1 surgeon. The team is responsible for elaborate resuscitation of in-patients from the general wards as well as out-patients coming for examination or for diagnostic and medicotechnical procedures. ⋯ Organization of the CHUV in this respect includes (a) grouping the facilities in larger areas where an alarm is signalled both optically and acoustically, (b) a special priority paging system with pocket radio-receptors (beeps) which can reach all members of the team within seconds, and (c) standardized resuscitation carts strategically located in the hospital. During a period of 7 months the team's work was judged satisfactory. It is called in once every 3 days on average.
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Intravenous acyclovir was tested both prophylactically and therapeutically in herpes infections in 48 patients undergoing bone marrow transplantation. Pretransplant prophylaxis only partly eliminated reactivated infections. Treatment of established mucocutaneous infections was usually successful, also in relapsing cases, when initiated within hours of the appearance of lesions. Extensive lesions, superinfections and dissemination could thus be prevented in this group of severely immunocompromised patients.
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Swiss medical weekly · Sep 1983
Case Reports[Hyperphosphatemia and tetany following phosphate enema].
Two patients with renal failure presented postoperatively with marked hyperphosphatemia and symptomatic hypocalcemia. This phosphate intoxication was due to a commonly used phosphate-containing enema. ⋯ The phosphate increase depends upon the retention duration of the enema. The use of phosphate-containing enemas in patients with renal failure is not entirely risk-free.