Swiss medical weekly
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Weaning patients from mechanical ventilation constitutes a major portion of the workload in an intensive care unit, as over 40% of total ventilator time is consumed by the weaning process. Several pathophysiological mechanisms may be responsible for weaning failure, but the precise role of each is incompletely understood. Patients who fail a weaning trial commonly develop hypercapnia, which appears to be due to decreased tidal volume rather than a primary decrease in respiratory drive. ⋯ Worsening of pulmonary mechanics will cause further embarrassment of the respiratory muscles. However, the clinical importance of respiratory muscle fatigue remains unclear. Afferent stimuli arising in the lung parenchyma, respiratory muscles, or as a consequence of impaired gas exchange will be transmitted to the respiratory control centers and result in severe dyspnea in patients who fail a weaning trial.
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Swiss medical weekly · Nov 1994
[Does physician's satisfaction with an initial consultation differ according to the patient's origin? A prospective study].
Difficulties in the doctor-patient relationship may arise because of differences in socio-cultural background. The aim of this study was to evaluate the doctors' satisfaction in an ambulatory care setting when confronted with 3 different cultural groups (Swiss, foreign residents, refugees) and to review some preconceived ideas. ⋯ Nevertheless, the doctors felt they had the same diagnostic accuracy in the 3 groups. Studies on the satisfaction of primary care doctors are important, because the quality of the doctor-patient relationship directly influences the quality of medical care.
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Swiss medical weekly · Oct 1994
Review[Therapy of primary pulmonary arterial hypertension: current status].
Primary pulmonary hypertension is a rare disease with a median survival of only 2.8 years after diagnosis. In this review article the minimal diagnostic workup is summarized and pathophysiological concepts are discussed. Therapeutic options today include oral anticoagulation, which has a proven survival effect. ⋯ In the majority of patients there will be no improvement, but possibly deleterious hemodynamic effects. Long term trials with both nifedipine and prostacyclin indicate a significant survival effect in those patients who initially respond to this treatment. Lung transplantation remains the only treatment option for patients with uncontrollable pulmonary hypertension.
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Acute shortness of breath is a common symptom of a variety of cardiac or pulmonary diseases. Prompt diagnosis of the underlying disease is a prerequisite for the initiation of appropriate therapeutic measures. Possible causes of dyspnea can be classified pathophysiologically as obstructive or restrictive ventilatory disorders, pulmonary vascular diseases and abnormal central regulation of breathing. In most cases the diagnosis can be suspected from an accurate history and thorough clinical workup, and confirmed by simple additional diagnostic procedures.
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Swiss medical weekly · Jul 1994
[Acute dyspnea in fluid overload: pathogenesis and differential diagnosis].
Pulmonary edema is a frequent complication in patients undergoing intravenous fluid therapy. Thorough and repeated clinical workup of the patients, along with few relevant laboratory data, are in most cases sufficient to analyze the factors which influence the Starling forces. This approach allows early detection of fluid overload and the development of pulmonary edema can be avoided.