Swiss medical weekly
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Swiss medical weekly · Jun 2000
Case Reports[R-hirudin (lepirudin, refludan) as an alternative anticoagulant in heparin-induced thrombocytopenia during cardiopulmonary bypass connection].
A 72-year-old patient with heparin-induced thrombocytopenia (HIT) and global cardiac decompensation underwent cardiac surgery using an extracorporeal circuit (ECC). For systemic anticoagulation r-Hirudin (lepirudin, Refludan) was administered as a heparin substitute during extracorporeal circuit. During cardiopulmonary bypass (100 min) the concentration of r-Hirudin was between 2.9 and 4.6 mcg/ml under continuous infusion of r-Hirudin at between 1.5 and 4.5 mcg/kg/min. ⋯ The further postoperative course was uncomplicated. After 3 days the patient came to nursing station and was discharged from hospital to a rehabilitation centre after 13 days. After a further 3 weeks he went home in a good general condition.
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Swiss medical weekly · Jun 2000
Review[Neurological diagnosis and prognosis: significance of neurophysiological findings in traumatic spinal cord lesions].
The clinical examination of patients with spinal cord injury can be supplemented by electrophysiological techniques (somatosensory evoked potentials [SSEP], motor evoked potentials [MEP], and electroneuromyographic recordings [ENMG]) to assess the extent and severity of a spinal cord injury. An essential advantage of these techniques in comparison with clinical examination is that they can also be reliably applied in uncooperative patients. These techniques allow early prognosis regarding the functional deficit in patients with acute spinal cord injury. ⋯ This is of prognostic value in regard to the development of muscle tone and consequently for planning of therapy. The electrophysiological examinations are of complementary value in the diagnostic assessment of spinal cord lesions, in the prediction of functional outcome, and in monitoring the course of neurological deficits. This is helpful for planning and selection of appropriate therapeutic approaches within the rehabilitation programme.
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Swiss medical weekly · Jun 2000
Review[Intensive care treatment concepts after traumatic spinal cord injury].
Spinal injuries are caused by strong traumatic impacts, followed not only by a local spinal reaction but also systemic involvement. The main problems in the early posttraumatic period are haemodynamic instability, pulmonary insufficiency and SIRS. ⋯ Optimum therapy for spinal injury patients is demanding and requires an experienced team for diagnosis as well as primary and secondary care. Close cooperation between intensive care and surgery is also important.
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Swiss medical weekly · May 2000
[Psychological comorbidity and quality of life of patients with morbid obesity and requesting gastric banding].
Bariatric surgical operations are well established in the treatment of morbid obesity. In this study, 79 consecutive applicants for laparoscopic gastric banding (60 females with a mean BMI of 47.4 kg/m2 and 19 males with a mean BMI of 48.9 kg/m2, mean age 39.6 years) were examined preoperatively by structured psychiatric interview and questionnaire.
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Swiss medical weekly · May 2000
Review[Mucous clearing respiratory-physiotherapy in pediatric pneumology].
Chest physiotherapy for mucus clearance may be seen as a therapeutic application of respiratory physiology; the basic mechanical principles do not differ between the treatment of paediatric and adult patients. However, children present with a developmentally defined, age-specific situation regarding respiratory structure and function that calls for a specialised therapeutic approach. Inspiration dilates bronchi and thus brings air behind obstructing mucus plugs. ⋯ However, lateral decubitus position does not affect ventilation in children in the same way as in adults. Disease-inflicted changes of structure and function call for further modification of the therapeutic approach. Finally, the psychology of therapist-patient interaction differs substantially between different age groups.