Swiss medical weekly
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Swiss medical weekly · Oct 1998
Clinical Trial[Effect of administration of recombinant human erythropoietin in acute normovolemic hemodilution on transfusion needs during total hip prosthesis implantation].
Acute normovolaemic haemodilution (ANH) is used to avoid perioperative blood loss and consists of the withdrawal of whole blood just before or just after anaesthesia induction and its simultaneous replacement by synthetic colloids and crystalloid solutions. In an attempt to improve the efficiency of this technique while at the same time avoiding cardiovascular complications, we set up a pilot study to test the association of rHuEpo/ANH during elective surgery for total hip replacement. Five patients (3 males, 2 females) were included in this study. ⋯ In conclusion, the stimulation of erythropoiesis by rHuEpo in the pre-surgery phase led on average to a 1 g/dl gain in haemoglobin, permitting an isovolaemic withdrawal of 900 to 1350 ml of blood depending on body weight without the development of severe anaemia. It was thus possible to perform total hip replacement in all the patients without homologous blood support and with a post-surgery haemoglobin value of > 10 g/dl. This protocol should be further tested in a prospective randomised study (rHuEpo versus placebo) in order to assess the real benefit of rHuEpo.
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Swiss medical weekly · Oct 1998
ReviewAccidents related to sleepiness: review of medical causes and prevention with special reference to Switzerland.
Sleepiness is a major cause of traffic accidents. Our purpose was to review determinants of accidents related to sleepiness and measures to prevent them. We performed a systematic literature review on the topic and studied official accident statistics and legislation regarding medical driving ability in Switzerland. ⋯ Swiss legislation authorizes physicians to report sleepy drivers to the authorities if they are thought to represent an accident risk for themselves or others. We conclude that sleepiness is a common but under-recognised cause of traffic accidents. Enhancing awareness of the problem in the public, early recognition and treatment of sleep disorders, and counselling of drivers with excessive sleepiness may contribute to prevention.
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The outcome of intensive care is related to patient selection and case-mix. Especially when assessing QOL, the results should be interpreted in the context of age and the cause of intensive care admission. Only a few QOL studies so far have databases which are large enough to characterize the outcome in specific patient groups. ⋯ While the QOL after intensive care as compared with reference values may be better perceived among older patients, the previously healthy and younger ones tend to experience more limitations. The reason for intensive care presumably has impact on the pattern of convalescence. A better understanding of the natural history of recovery from critical illness may help to identify those patients who need more intensive rehabilitation.
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Swiss medical weekly · Sep 1998
ReviewMyocardial dysfunction in sepsis: clinical and experimental investigations.
To review the clinical manifestations and mechanisms of cardiac dysfunction in septic shock. ⋯ Serious bacterial infections result in inflammatory injury to the heart manifested by a common profile of cardiac dysfunction. Therapy remains limited to treatment of the infection with antibiotics and supportive care, with fluid resuscitation and selective use of inotropes and vasopressors. Experimental models suggest that new anti-inflammatory strategies (e.g. tyrosine kinase inhibitors) may offer some advantages over those that target a single mediator; these agents remain to be clinically evaluated.