Swiss medical weekly
-
Swiss medical weekly · Sep 2004
Gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL): analysis of overdose cases reported to the Swiss Toxicological Information Centre.
We analysed 141 cases of Gamma-hydroxybutyric acid (GHB) and Gamma-butyrolactone (GBL) intoxication reported by physicians to the Swiss Toxicological Information Centre between 1995 and 2003. GHB and GBL intoxication are associated with considerable morbidity. Multiple drug use is common. Overdosing frequently results in non-reactive coma, which accounts for the severity of the intoxication and the costs occasioned by management.
-
Swiss medical weekly · Jul 2004
Decompressive craniotomy after middle cerebral artery infarction. Retrospective analysis of patients treated in three centres in Switzerland.
Several studies have reported an improved outcome in patients presenting with complete middle cerebral artery (MCA) infarction treated by decompressive hemicraniectomy. Although this palliative treatment form has gained popularity in Switzerland since 2000, the results of these series have not been reported. The aim of this study is, firstly, to report factors influencing the outcome of our patients, in order to create awareness of the indications and decision-making processes in our departments, and, secondly, to analyse therapeutic strategies which are open to improvement and standardisation. ⋯ The outcome in patients undergoing decompressive craniectomy after MCA infarction in Switzerland is less favourable than in other series recently reported. Less favourable preoperative clinical condition, inclusion of dominant hemispheric infarction, poorly defined protocols and late involvement of neurosurgeons on these patients' admission may explain the results.
-
Swiss medical weekly · Jul 2004
Is the fall in platelet count associated with intensive care unit acquired pneumonia?
Intensive Care Unit Acquired Pneumonia is the most frequent infection among patients receiving mechanical ventilation and has an important impact on patient mortality. Thrombocytopenia is one of the most common laboratory abnormalities in Intensive Care Unit (ICU). The aim of this study was to evaluate the relationship between platelet count and Intensive Care Unit Acquired Pneumonia (ICUAP). ⋯ Besides the proven role of thrombocytopenia in prognosis in ICU, the significant fall in platelet count can be an early warning parameter and possible diagnostic hint for severe infections in ICU such as ICUAP.
-
In critically ill patients, adequate analgesia and sedation increase comfort, reduce stress response and facilitate diagnostic and therapeutic procedures. Analgesia and sedation may also have a beneficial impact on morbidity, particularly by reducing pulmonary complications such as atelectasis and pneumonia, and delirium or agitation with subsequent accidental extubation. The method and depth of analgesia and sedation should be adapted to the needs of the individual patient. ⋯ In Europe, midazolam and propofol are most frequently used for sedation of the critically ill. Regular evaluation of the effect of these drugs and subsequent adaptation of dosage are more important than the choice of specific analgesics and hypnotics. Implementation of guidelines for rational analgesia and sedation would help to reduce patients' length of stay in the intensive care unit.
-
Swiss medical weekly · Apr 2004
Editorial CommentInhalation of aerosols by children: an ongoing controversy.