Swiss medical weekly
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Encephalitis is the result of focal or global inflammation of the brain caused by invasion of the brain parenchyma by viruses, bacteria, parasites or fungi. In addition, postinfectious encephalitis may result from immunological processes as a consequence of preceding viral infections such as measles. For most forms of viral encephalitis no specific therapy is available. ⋯ Herpes simplex encephalitis responds well to treatment with acyclovir, as does encephalitis caused by varicella-zoster virus, which typically occurs following cutaneous herpes zoster involving dermatomal distributions of the trigeminal nerve. In immunocompromised hosts many etiologies of encephalitis need to be considered. It is important to arrive at a precise diagnosis in order to choose appropriate therapeutic agents directed toward treatable pathogens such as Toxoplasma gondii and cytomegalovirus.
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We describe 4 patients with syncopes due to tachycardias of different etiologies. The causes and prognostic importance of syncopes are discussed together with the therapeutic options, e.g., antiarrhythmic therapy guided by programmed ventricular stimulation, surgery for ventricular tachycardia, implantation of a cardioverter/defibrillator, and radiofrequency ablation of arrhythmias. In particular, the clinical presentation of arrhythmogenic right ventricular dysplasia and Wolff-Parkinson-White syndrome are outlined.
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During a 6-year period from 1986 to 1991, 119 patients with lung cancer underwent thoracotomy. 112 underwent surgical resection with lymphadenectomy. The mean age of the 97 male patients was 62.7 years, and of the 15 female patients was 62.7 years, and of the 15 female patients 57.1 years. 54 patients were in stage I, 23 stage II, 21 stage IIIa, 8 stage IIIb and 6 stage IV. Pneumonectomy was performed in 20 cases, bilobectomy in 2, lobectomy in 81, segmentectomy in 3 and sleeve lobectomy in 6. ⋯ Serious complications occurred in 19% of all thoracotomy patients. The re-thoracotomy rate was 6% and mortality 0.8%. The cumulative 5-year survival rate in all 112 patients with surgical resection was 54.6%, and for the 54 patients with radical resection 60.3%.
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Swiss medical weekly · May 1994
Case Reports[Fulminant purpura in Still's disease and bacteremia with Xanthomonas maltophilia and coagulase-negative staphylococci].
We describe the case of a 31-year-old man with a long history of juvenile rheumatoid arthritis who was admitted to the hospital because of painful purple skin lesions on hands and feet. On admission he presented the classical picture of "purpura fulminans" with extensive acrocyanosis and large blisters on the lower limbs which evolved into symmetrical peripheral gangrene. ⋯ Coagulation studies two months after the acute phase of the disease revealed chronic activated coagulation with a significant protein S deficiency. Clinical findings, etiology, significance of impaired coagulation and therapeutic action in "purpura fulminans" are discussed.
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Percutaneous endoscopic gastrostomy is the preferred method for administration of long-term enteral tube feeding. Data on long-term follow-ups are rare. We report the long-term outcome and the complication rates after percutaneous endoscopic gastrostomy in 165 patients (mean age 70 years). ⋯ There were 12% tube-related and 15% feeding-related late complications, the main ones being local skin infections (7.3%) and gastric perforations (1.2%). The procedure-related mortality was 0.6%. We conclude that endoscopically assisted percutaneous gastrostomy is the procedure of choice for long-term enteral nutrition in patients requiring tube-feeding.