Swiss medical weekly
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Swiss medical weekly · May 1998
Arousal responses to inspiratory resistive loading during REM and non-REM sleep in normal men after short-term fragmentation/deprivation.
The arousal response to inspiratory resistive loading in normal men is known to be high during REM sleep compared to non-REM sleep. We investigated whether we could observe the same pattern, i.e. brisk arousal from REM sleep compared to non-REM sleep, in normal subjects who had undergone short-term sleep fragmentation/deprivation prior to the investigation. The arousal response to the repeated application of an external inspiratory resistance of 25 cm H2O/l/s was determined during REM and non-REM sleep in 10 healthy men after a single night with 4 hours of acoustically fragmented sleep. ⋯ Despite short-term sleep fragmentation/deprivation the night before the study, the arousal response to external inspiratory resistive loading was brisker during REM than non-REM sleep in the healthy subjects studied. The responses were of the same magnitude as those induced in prior studies without pretest sleep disturbance. This is different from what is seen in patients with sleep apnea, where breathing disorders are worst during REM sleep and sleep fragmentation/deprivation leads to rapid deterioration of arousal responses to the spontaneously occurring airway occlusions.
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Swiss medical weekly · Apr 1998
[Intensive monitoring of patients with acute cerebral ischemia within the scope of a coordinated stroke treatment concept: initial experiences].
It has been shown that the prognosis of patients with stroke can be improved by specialized stroke units. Whether any additional benefit can be achieved by use of intensive care resources is unknown. Therefore, it was the purpose of this study to analyze our first experience of management of patients with acute ischaemic stroke in an intensive care unit, as part of a newly implemented coordinated stroke concept. ⋯ In the present analysis, an unexpectedly high incidence of relative arterial hypotension was observed in patients hospitalized in an intensive care unit for acute ischaemic stroke. Therapeutic measures were restricted mainly to blood pressure control and anticoagulation/antithrombotic treatment. Specific therapies for neurologic complications or interventions requiring the resources of an intensive care unit were not used. Whether defined patient groups with ischaemic stroke will benefit from specific treatment in an intensive care unit needs to be tested by controlled, randomized studies.
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Swiss medical weekly · Apr 1998
[Age-related seroprevalence of measles, mumps and rubella antibodies in 1996].
In 1996 the effects on the immunity profile of a Swiss population exposed to MMR vaccination, which has been recommended since 1985, were evaluated with an age-stratified seroprevalence study for measles, mumps and rubella (MMR). At the age of 1.5-2.5 years, seroprevalence attained 76% for measles and rubella, which is respectively 17% and 24% above the values observed in 1992. The seroprevalence for mumps attained only 55% at the same age, which could reflect the poor immunogenicity of this component of the MMR vaccine. ⋯ The poor efficacy of the mumps component of the MMR vaccine that has mainly been used in Switzerland is also evident. The average age at infection is therefore expected to rise, thus involving a risk of increasing age-dependent complications. Efforts to implement the MMR vaccination program in Switzerland should be improved.
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Swiss medical weekly · Mar 1998
Review[Long-term home oxygen therapy: who? with what? how expensive?].
Since 1981 long-term oxygen therapy (LTOT) has become an important procedure for the rehabilitation of patients with chronic respiratory insufficiency in Switzerland too. As a result of long-term clinical experience as well as technical progress, there is, however, increasing need for an updated reassessment of guidelines and standardized management respectively: the indications for LTOT-so far restricted to patients with COPD-are extended to patients with pulmonary diseases other than COPD associated with chronic hypoxemia (pO2 < 7.3 kPa) provided there is enough evidence of clinical benefit. Another important aspect of LTOT focuses on the appropriate application of different oxygen sources. ⋯ To organize and follow-up LTOT in Switzerland, a very efficient concept was introduced many years ago which is characterized by economical cooperation between physicians, insurances, technical suppliers and social providers. Today more than 3000 patients-corresponding to 38/100,000 inhabitants-benefit from LTOT. Future perspectives should target an earlier start to continuous as well as mobile LTOT, in order to improve rehabilitation in still active conditions instead of merely palliating the terminal stages.
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Swiss medical weekly · Feb 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of propacetamol and morphine in postoperative analgesia].
To compare the analgesic efficacy and tolerance of propacetamol and morphine, 80 patients in good clinical condition were included in a prospective, parallel, randomized double blind trial after elective surgery expected to elicit light to moderate postoperative pain. At the end of general anesthesia, 40 patients received 30 mg/kg propacetamol and 40 0.2 mg/kg morphine, as a 15-min intravenous infusion. The groups were similar for age, weight and duration of anesthesia. ⋯ No significant differences were observed in blood oxygen saturation, blood pressure, heart rate, body temperature and vigilance evaluated by the trailmaking test. Nausea was present in 4 cases under propacetamol and 3 under morphine, and pruritus in 2 and 7 cases, respectively. In conclusion, propacetamol may represent an alternative to morphine for pain prevention after mildly to moderately painful surgery in situations where the use of opioids is unsuitable.