Swiss medical weekly
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Swiss medical weekly · Mar 1996
Case Reports[Iatrogenic complications and quality improvement in everyday medical practice].
There is a relationship between iatrogenic complications of medical procedures and the quality of medical services. The risk of iatrogenic complications or diseases occurring is growing over time for several reasons: patients under medical care grow older and sicker, diagnostic and therapeutic procedures are expanding at a fast pace, and complexity and uncertainty in daily care tends to grow. This development will continue unless we actively start to prevent iatrogenic complications. ⋯ Necessary procedures must be performed at the most skilled level. We describe and discuss two cases of iatrogenic complications and the benefits and disadvantages of guidelines. The creation of guidelines should be placed on a rational and scientific basis.
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Since antiquity medicine has repeatedly been accused of being noxious (or ineffective). Physicians have always admitted that their art-because of its efficacy-could be dangerous. Lack of success or unwanted effects stimulate research in quest of a better definition of efficacy and to improve safety. In practice, however, it is necessary to act here and now, by the available means, hopefully in line with Hippocrates' precaution,
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Swiss medical weekly · Mar 1996
Review[Shoulder problems in leisure athletes: physical examination, diagnosis and therapy. Sensible procedures in daily practice].
At first sight the anatomy of the shoulder may seem simple (see Fig. 1). However, for the physician treating a patient suffering from shoulder pain, the scapulo-thoracal interplay of 5 joints and 19 muscles, providing a wide and varied range of motion, may constitute an obstacle difficult to overcome. ⋯ Contact sports in particular tend to involve risks of falling on the shoulder, injuring the shoulder girdle or the elbow and wrist, sometimes with major consequences: complex fractures, dislocations, ligament and tendon lesions or joint instabilities. Thorough, rapid and cost-effective diagnostic evaluation of the athlete, involving clinical examination (function tests), radiographic imaging (shoulder a.p., y-view) and in selected cases ultrasonography (compared with the other side) may be necessary in starting early and effective therapy.
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Swiss medical weekly · Mar 1996
Review[Primary ciliary dyskinesia, immotile cilia syndrome, and Kartagener syndrome: diagnostic criteria].
Primary ciliary dyskinesia is the generic term for a heterogeneous group of inherited diseases in which ciliary ultrastructure is defective and as a consequence ciliary motility is disturbed. An international consensus on the diagnostic criteria has not yet been reached. This paper reviews some recent findings which are useful in the diagnosis of the disease and attempts to establish the best diagnostic criteria. ⋯ Primary and secondary ciliary dyskinesia can be distinguished by these methods and the rare case of PCD without ultrastructure deficiency ruled out. In special cases a cell culture is recommended for the diagnosis. Practical aspects of the sampling methods and diagnostic pitfalls are reviewed.
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Swiss medical weekly · Mar 1996
Review[High-resolution computerized tomography of the lungs: bases, findings, indications].
High resolution computed tomography (HRCT) of the lungs uses thin-section CT (1- to 2-mm collimation scans) combined with a targeted reconstruction with a high-spatial frequency algorithm. HRCT is currently the most sensitive non-invasive imaging method for parenchymal and bronchoscopically inaccessible bronchial abnormalities of the lung. The following indications for HRCT of the pulmonary parenchyma are established: (1.) complementary examination in symptomatic patients with normal chest radiographs and/or normal pulmonary function testing; (2.) morphologic characterization of a nonspecific radiographic pattern; (3.) assessment of the activity and follow-up of a parenchymal disease; (4.) localization of a lung biopsy; (5.) localization of bronchiectasis.