Swiss medical weekly
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Swiss medical weekly · Mar 1980
Case Reports[Progressive encephalopathy in 3 cases of chronic lymphoid leukemia].
Three patients suffering from a lymphoproliferative syndrome developed, late in the course of the disease, a neurological disorder with the signs and symptoms of a progressive multifocal leukoencephalopathy (PML). This diagnosis was confirmed in the first patient. ⋯ The involvement of the CNS in the evolution of lymphoproliferative disorders becomes more and more frequent, probably due to the prolonged survival time of patients undergoing chemotherapy and the immunosuppressive effects of such treatment. Biopsy is the only method of distinguishing PML from a cerebral leukemic infiltration; this is obviously important in view of the different therapeutic approaches used for the two diseases.
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Swiss medical weekly · Mar 1980
Case Reports[Loss of 2 kidney grafts due to recurrence of type II membrano-proliferative glomerulonephritis].
Recurrent glomerulonephritis after renal transplantation is seen in a very high percentage of patients with dense "deposit" disease (= membrano-proliferative glomerulonephritis type II). However, loss of graft due to recurrence is rare; only 4 cases have been reported. ⋯ Both had recurrent dense "deposit" disease with extracapillary proliferation and crescent formation. In one of them, a quiet initial phase of 20 months was followed by an extremely rapid progression of the disease leading to loss of graft function within 3 weeks.
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In a critically ill patient referred to an intensive care unit, clinical evaluation remains the first method in the assessment of cardio-circulatory status. In more complex cases direct measurement of standard hemodynamics must be performed at the bedside, for instance by the use of a Swan-Ganz thermodilution catheter. As alternatives to hemodynamic parameters, non-invasive techniques for the evaluation of left ventricular function such as echocardiography, radionuclide angiography, measurement of systolic time intervals and electrical impedance are presented. Their indications and limitations in comparison with hemodynamics are discussed.
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15 outpatients with type II hyperlipoproteinemia (7 with type IIa and 8 with type IIb) were treated with soybean. This diet induced a significant decrease of plasma cholesterol levels from 314 +/- 24 to 267 +/- 30 mg/100 ml. ⋯ In our efforts to reduce hyperlipidemia the very low cost of these vegetable proteins is a further advantage. The hypocholesterolemic mechanism of soybean diet is unknown.
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Swiss medical weekly · Nov 1979
[Continuous monitoring of intracranial pressure and new aspects of neurologic intensive care for children].
A new concept of neurointensive care is presented which is based on earily measured parameters such as intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) (CPP = MAP - ICP). ICP should preferably be measured by a subarachnoid hollow screw (Richmond screw). Of chief importance in neurointensive care (after adequate neurodiagnosis) is the avoidance or treatment of cerebral edema and maintenance of sufficient CPP, which should be above 50 mm Hg in older children. ⋯ To obtain the indication for ICP monitoring, the depth of the disturbance of consciousness is measured by the Glasgow Coma Scale. Children with the aforementioned affections and a Glasgow Coma Scale below 6 to 8 should be treated as outlined above. The data published in the literature and our own experience point very much in this direction, especially for severe head injury, Reye's syndrome and near drowning.