Swiss medical weekly
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Swiss medical weekly · Oct 1999
[High-risk PTCA assisted by the Hemopump 14F: the Geneva experience].
The hemopump is a transvalvular, catheter-mounted, left ventricular assist device, intended for surgical placement via the femoral artery (hemopump 21 Fr. outer diameter). This device has demonstrated its ability to unload the left ventricle, leading to myocardial protection and haemodynamic stabilisation in patients with cardiogenic shock and those undergoing high-risk coronary angioplasty (PTCA). Since 1994, a new hemopump system (14 Fr. in external diameter, flow rates of 1.5-2.2 l/min) has been developed for percutaneous insertion. The aim of this study is to describe the immediate and mid-term results obtained during Hemopump 14 Fr. assisted high-risk PTCA. ⋯ The 14 Fr. Hemopump device may constitute a useful percutaneous mode of haemodynamic support for patients undergoing high-risk PTCA. The haemolysis it causes is mild and not clinically significant, but the hemopump is associated with a significant rate of local vascular complications. Recent improvements in interventional techniques and hardware have decreased the necessity for circulatory assistance during elective PTCA, even for very ill patients. Nevertheless, indications such as cardiogenic shock, the "bridge" period prior to heart transplantation and video-assisted minimally invasive cardiac surgery, or haemodynamic support of the right ventricle are the new applications of the hemopump.
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Swiss medical weekly · Oct 1999
Comparative Study Clinical Trial Controlled Clinical Trial[Water precautions after insertion of a tympanostomy tube: necessary or obsolete?].
Since the introduction of tympanostomy tubes by Armstrong in 1952, physicians and patients alike have been concerned about the possible harm associated with water entering the middle ear via tubes. It is the current practice of many physicians to advise patients to avoid water entering the middle ear by using water precautions when swimming. However, the potential harmful effect of water in causing otorrhoea and otalgia still remains controversial. ⋯ In patients with tympanostomy tubes swimming without water precaution does not predispose to otorrhoea. On the basis of this study, previous investigations using in vitro models, and the literature, it is currently our practice to permit children to swim without water precautions two weeks after insertion of a tympanostomy tube.
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Swiss medical weekly · Oct 1999
Review[Activation of plasma cascade systems in sepsis: role of C1 inhibitors].
During sepsis the complement system, the contact activation system and the coagulation cascade are activated. Activation of these plasmatic cascades contributes to the development of multiple organ failure and the high mortality rate of severe sepsis and septic shock. C1-inhibitor is the main inhibitor of the classical pathway of the complement system (C1s and C1r), of the contact activation system (factor XIIa and kallikrein) and of the intrinsic pathway of coagulation (factor XIa). ⋯ C1-inhibitor has been shown to attenuate the activation of the complement system and the contact activation system and to improve hypotension. Based on this convincing pathophysiological concept and the results of the animal studies, we initiated the "Bernese C1-inhibitor study", a randomised double-blind and placebo-controlled pilot study involving administration of C1-inhibitor to patients with severe sepsis or septic shock. If the results of this pilot study confirm the results of the reports mentioned above, they will serve as a base for larger multicentre studies.
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Whiplash-associated disorders (WAD) represent a class of clinical complaints which commonly result from rear-end car accidents. An automobile collision can generate major forces which are transferred to the neck by an acceleration-deceleration mechanism (whiplash), resulting in bony or soft-tissue injuries (whiplash injury). Incidence of WAD is estimated to be 0.1 to 3.8/1000/year; WAD cost $29 billion a year in the USA. ⋯ In particular the most important questions (how can patients with acute and chronic disorders be helped best) have no clear answer yet. Furthermore, there are many opinions and prejudices (especially concerning psycho-social factors of WAD) which have no scientific basis. Therefore, an intensive exchange of information between health care professionals, patients and the general public appears to be very important.
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Pica is the collective term for any form of qualitative disorder of eating behaviour. If a patient's deviant appetite is fixated on one special object, there are quite a number of corresponding terms available (e.g. geophagia for eating dirt). ⋯ The author briefly summarizes the medical history of the pica concept and the present state of knowledge concerning aetiology and pathogenesis. The numerous possible complications and various therapeutic approaches are pointed out.