Swiss medical weekly
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Swiss medical weekly · Aug 1997
[PFAPA syndrome: periodic fever, adenitis, pharyngitis and aphthous stomatitis].
A syndrome involving periodic fever, pharyngitis, adenitis and aphthous stomatitis is described in 8 children. Attacks are characterized by abrupt onset of fever and, in addition to the above symptoms, by malaise, headache and abdominal pain. Mild leukocytosis and elevation of the erythrocyte sedimentation rate are found in the laboratory. ⋯ No patient has exhibited atypical lymphocytosis or neutropenia, and all patients had normal levels of immunoglobulin. All had received antibiotics early in the course of their illness but without effect. Cimetidine has been discussed in the literature as a possible treatment, but the results are controversial.
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Swiss medical weekly · Jul 1997
Case Reports[The "pinch off" syndrome: a complication of implantable catheter systems in the subclavian vein].
We report the case of a 63-year-old male patient who received a subcutaneous Port-a-cath system in the right subclavian vein for administration of chemotherapy. Five weeks after successful use, flushing with NaCl 0.9% caused a painless subcutaneous swelling. Fluoroscopy confirmed a leakage below the right clavicle. ⋯ Two weeks later another leakage occurred and the catheter was removed definitively. Defective equipment was ruled out by the catheter producing company. The "pinch off" syndrome, a rare phenomenon of catheter compression and consecutive catheter fracture, is described, together with the diagnostic signs, the incidence and preventive measures suggested in the literature.
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Despite more than 25 years of extensive research, the mortality of ARDS patients remains high. The inflammatory process within the lung and the associated gas exchange disturbances require an aggressive ventilatory regimen, which itself may harm the lung. Therapeutic measures which are used to reduce iatrogenic damage to the lung are pressure controlled mechanical ventilation in combination with PEEP and permissive hypercapnia, dehydration and extracorporeal gas exchange. ⋯ In ARDS, inhalation of NO may cause a predominantly selective vasodilation in blood vessels of ventilated lung regions, resulting in an increase in PaO2 and a decrease in pulmonary artery pressure. The effect of NO on the pulmonary vasculature also induces a reduction in right ventricular afterload and also in pulmonary capillary pressure, which may lead to a faster resolution of pulmonary edema. However, in spite of the promising results of these new strategies, further studies are needed to evaluate their influence on morbidity and mortality.
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The main goal of intensive care of potential organ donors includes the maintenance of the organs' function with respect to their integrity after transplantation. Profound disturbances of cardiovascular, respiratory and endocrinological function may lead to early organ loss. Therefore, comprehensive therapy is required from the onset of brain death. The major dysfunctions and therapeutic goals in organ donors are summarized on the basis of current literature and our own findings.