Swiss medical weekly
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Swiss medical weekly · Aug 1983
[Treatment of cardiogenic shock in acute myocardial infarction and postoperative low cardiac output].
The extent of myocardial and coronary lesions, the failure of the mechanisms regulating coronary blood flow, and the inadequacy of adrenergic stimulation account for the difficulties in managing cardiogenic shock as a complication of acute myocardial infarction. Except in cases of hypovolemia, excessive bradycardia, the only adequate treatment is IABP. However, long-term survival is observed only in patients undergoing surgery for a mechanical complication after control of the cardiogenic shock. Finally, the causes of the post-CPB low output syndrome and the principles of their management are discussed.
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Swiss medical weekly · Aug 1983
Comparative Study[Are beta-sympathomimetic substances in resuscitation useful? Experimental studies].
Orciprenaline and epinephrine have been compared in cardiopulmonary resuscitation (CPR) in the dog. In a third group no substance was given. When orciprenaline was repeated without success, epinephrine was given. ⋯ In the epinephrine group defibrillation led directly to adequate circulation, whereas in the orciprenaline group subsequent electromechanical dissociation was observed. It is concluded that beta-receptor stimulators have no place in CPR. Epinephrine is the drug of choice in resuscitation after cardiac arrest.
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Swiss medical weekly · Jul 1983
Case Reports[A patient with 46 XX/46 XY chimerism without hermaphroditism. The problem of prepuberal diagnosis of the Klinefelter's syndrome].
In a 12-year-old obese boy whose parents had asked for determination of sex chromatin the result was positive and Klinefelter's syndrome was diagnosed. Subsequently, the boy developed normally, went through puberty and presented with normal primary and secondary sex characteristics at the age of 22. ⋯ In contrast to our patient, most dispermic chimeras are hermaphrodites. This case exemplifies the fact that Klinefelter's syndrome should not be diagnosed in prepubertal boys on the basis of positive sex chromatin.
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Alcoholic cirrhosis is frequently accompanied by hematologic abnormalities. The most commonly observed factors responsible for combined or isolated cytopenias are alcohol, malnutrition, hypersplenism and liver dysfunction. In addition to cytopenia, functional abnormalities, particularly of the leukocytes and of the platelets, have been described. In patients with hemorrhage the severity of the hemostatic defect is influenced not only by the number and function of the platelets, but also by a decrease in several coagulation factors synthesized by the liver and by an increased level of circulating fibrinolytic activators.
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Within a period of 6 years 8 patients with 12 bites by potentially hemotoxic snakes (crotalids, viperids) were hospitalised in various clinics of the Basle area. All the patients were snake owners. One patient was hospitalized 3 times, 2 patients twice and the others once. ⋯ Antivenin was used in three patients and coagulation mechanisms recovered within 24 hours. One patient with complete defibrination, thrombopenia and overt bleeding (macrohematuria) refused antivenin. His coagulation parameters started to improve after 7 days and became normal on day 11.