Swiss medical weekly
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Swiss medical weekly · Feb 1994
[Aortic valve stenosis in the old age: clinical and echocardiographic aspects].
Among 380 consecutive patients > 70 years of age, patients with a systolic heart murmur were investigated both clinically and by doppler echocardiography. The aim of the study was to compare the validity of the clinical diagnosis of valvular aortic stenosis in elderly patients with the results of doppler echocardiography. 138/380 patients (36%) had a systolic heart murmur. 130 were investigated by doppler echocardiography. 23/130 patients with systolic murmur (18%) had moderate or severe aortic stenosis. Clinically, patients with moderate or severe aortic stenosis had a pulsus parvus et tardus of the carotid artery more often than patients with only slight or no evidence of aortic stenosis (61% vs 16%; p < 0.0001). ⋯ We conclude that moderate or severe aortic stenosis is a frequent finding in elderly patients. Diagnosis by clinical examination may be difficult. For this reason, doppler echocardiography should be performed, especially when therapeutic consequences are to be expected from the diagnosis, such as aortic valve replacement or vasodilator treatment in the case of congestive heart failure.
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Swiss medical weekly · Feb 1994
[Role of the respiratory muscles in weaning from mechanical ventilation].
Weaning from mechanical ventilation is difficult when the respiratory muscles are unable, because of weakness or fatigue, to assume the entire work of breathing. Partial ventilatory support may then be used to rest the respiratory muscles. However, the degree of muscle rest achieved varies according to the ventilatory mode. ⋯ With noninvasive techniques, muscle rest is better achieved by positive pressure than by negative pressure ventilation. The opposite option, training of the respiratory muscles, has also been found to facilitate difficult weaning. The role of resting and overloading the respiratory muscles in the management of difficult weaning remains to be established.
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Swiss medical weekly · Dec 1993
[Seasonal variations in arterial pressure in hypertensive patients].
Blood pressure (BP) was measured once every month during one year in 80 hypertensive outpatients. An orthostatic test was performed in winter and another during summer. The collective was aged 65 +/- 13 years (m +/- SD) and presented an elevated prevalence of diabetes mellitus, cardiac failure, and coronary, cerebral and arterial insufficiency. ⋯ The orthostatic test induced a greater immediate fall in systolic BP in summer than in winter (-14.4 vs -9.6 mm Hg, p < 0.001), more orthostatic hypotensive episodes defined as a systolic BP fall of 20 mm Hg or more (34% of patients vs 20% in winter, p = 0.05) and more signs of reduced cerebral perfusion (14% vs 7.5% in winter, NS). Diabetic patients and patients treated by diuretic and vasodilator drugs are particularly exposed to orthostatic hypotension in summer. Betablockers can minimize this risk.(ABSTRACT TRUNCATED AT 250 WORDS)
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Transesophageal echocardiography (TEE) has proven to be a safe and useful method in open heart surgery. TEE allows the anesthesiologist to monitor global and regional ventricular function continuously and to optimize hemodynamic management. It offers the cardiac surgeon additional information and more safety with regard to planning and conduct of surgery as well as the possibility of immediate assessment of the surgical result. Correctly applied, TEE improves the overall quality of perioperative patient care.
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Swiss medical weekly · Oct 1993
Congenital heart disease in the adult: problems for the adult cardiologist.
Adult congenital heart patients form a growing group of patients. General principles of diagnostic and therapeutic needs in this group are discussed including the special organizational requirements for this new medical community.