Swiss medical weekly
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Swiss medical weekly · Oct 1997
Review[Multidimensional geriatric assessment in the acute hospital and ambulatory practice].
Comprehensive geriatric assessment (CGA) is defined as a multidimensional medical, functional, psychosocial and environmental evaluation of an older person's problems and resources, linked with an overall plan for treatment and follow-up. It is well established that CGA implemented in specialized geriatric evaluation and management units improves function and survival in frail older patients. The results of new randomized controlled trials, however, show that the application of CGA does not only improve outcomes in selected older persons, but probably in most. ⋯ Annual comprehensive geriatric assessments with preventive home visits in older people living at home resulted in fewer nursing home admissions and delayed or prevented the onset of disability in the activities of daily living in persons of the intervention group as compared to controls. One of the roles of geriatricians is teaching CGA and conducting further research with a view to refining CGA methodology and its application. Practical application of the principles of geriatric assessment and management, however, should not remain in the hand of specialists alone, but should become an integrated part of primary care medicine in the ambulatory and hospital settings.
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When physicians encounter pregnant patients with respiratory complaints, they face a challenging set of clinical problems. To understand the clinical cardiopulmonary manifestations of diseases occurring during pregnancy, knowledge of the basic physiologic changes during pregnancy is necessary. ⋯ Clinical symptoms, diagnosis and treatment of most diseases do not differ from those in the nonpregnant state. However, pharmacotherapy presents unique aspects, since not only may pharmacokinetics differ, but the fetus must also be assumed to be a recipient of the drug.
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It is generally accepted that since the end of the Second World War, English has become the main language in the medical field in Switzerland, but scarcely any objective data are available on the development of this process in this country. The aim of the present study was to analyze the frequency of the different languages in the literature references in articles published in the Swiss Medical Weekly over the past 75 years, with special attention to the possible differences existing between articles originating in German-speaking Switzerland and French-speaking Switzerland. ⋯ (1) Between 1945 and 1995 the percentage of literature references in English has increased continuously, while the percentages of references in German and French have decreased. (2) English replaced German as the main language of medicine towards 1955 in French-speaking Switzerland and towards 1965 in German-speaking Switzerland. (3) During the whole period studied (1920-1995), French-speaking authors cited publications in German more frequently than German-speaking authors cited publications in French. (4) The evolution of the relative importance of the languages in German-speaking Switzerland is very similar to that previously described in Germany and Austria. (5) In French-speaking Switzerland, on the other hand, the evolution of the relative importance of the different languages differs very considerably from that previously described in France.
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Swiss medical weekly · Sep 1997
[Perioperative gastrointestinal ischemia in abdominal aortic aneurysm operations].
Surgery of abdominal aortic aneurysms involves a high risk of postoperative complications. It has been suggested that the incidence of postoperative complications is related to the development of gastrointestinal acidotic episodes of the mucosa. The goal of this study was, therefore, to determine the incidence of gastrointestinal acidotic episodes during repair of abdominal aortic aneurysms, and to test the hypothesis that these episodes predict an adverse postoperative course. ⋯ Perioperative gastrointestinal acidotic episodes of the mucosa are common during repair of abdominal aortic aneurysms. The perioperative course, however, is not influenced by these acidotic episodes, despite the fact that patients with complications during their stay in the intensive care unit had lower perioperative pHi values. The routine use of pHi measurements during elective surgery of abdominal aortic aneurysms, therefore, is not justified.
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Swiss medical weekly · Sep 1997
[Acute type B aortic dissection: prognosis after initial conservative treatment and predictive factors for a complicated course].
Today there is still debate concerning the optimal mode of treatment for type B dissection of the aorta. Controversies are mainly due to discordant results regarding survival following medical or surgical treatment. We assessed the early and long-term outcome of acute dissection of the descending aorta after initial conservative treatment. ⋯ Currently, surgery for acute type B dissection is limited to patients with rupturing disease, distal malperfusion or uncontrollable hypertension and pains. Despite aggressive antihypertensive treatment, hospital mortality after primary conservative treatment is still high and a substantial proportion of patients requires surgery during initial hospitalization. Although conservative treatment is recommended in most uncomplicated type B aortic dissections, early surgery should be considered in the following situations: younger patients with 5 cm diameter of the aorta at initial evaluation, as well as those with Marfan syndrome, patients with limited false aneurysm or retrograde dissection into the aortic arch, and those with poor medical compliance or uncontrollable proximal hypertension. Radiographic follow-up for an indefinite period may allow detection of potential late complications and proper planning of elective operations when indicated.