Swiss medical weekly
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Since the introduction of transesophageal transducers, Doppler echocardiography allows to detect aortic dissection with high sensitivity. The extent of the dissection can be determined accurately and the possibility of conducting the examination at bedside is particularly advantageous. Caution is advisable in interpreting doubtful observations in the distal part of the ascending aorta, which often ist incompletely visualized.
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Alcoholic ketoacidosis (AKA) is an important and probably underdiagnosed differential diagnosis for metabolic acidosis with an increased anion gap. It occurs in patients with prolonged ethanol intake. ⋯ Routine testing for urine or serum ketones with ketostix may be negative, since they do not detect beta-hydroxybutyrate and this is characteristically elevated in AKA. We present three cases of AKA and discuss diagnosis, pathophysiology and management of this disorder.
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Swiss medical weekly · Oct 1993
Case Reports[Thrombosis of the right auricle in pulmonary embolism: value of echocardiography and indications for thrombolysis].
The presence of a right atrial thrombus is a recognized predictive factor of high mortality in patients with pulmonary embolism. In this report we describe two cases in which a free-floating thrombus in the right atrium was demonstrated by echocardiography; it resolved rapidly in both cases after thrombolytic therapy which resulted in a rapid clinical improvement and favorable outcome. ⋯ In cases of massive pulmonary embolism or when there is doubt regarding the diagnosis, this noninvasive method serves to guide diagnostic and therapeutic decisions. In the special case where a right atrial thrombus is detected by echocardiography, thrombolytic therapy seems warranted.
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Swiss medical weekly · Oct 1993
Multicenter Study Clinical Trial[Childhood treatment of paroxysmal supraventricular tachycardia using i.v. adenosine].
Paroxysmal supraventricular tachycardia is the most frequent significant arrhythmia in the pediatric age group, especially in the first year of life. In neonates and infants there are important limitations for the commonly used drugs such as verapamil and digitalis. ⋯ A major disadvantage are recurrences in about one third of cases. We conclude that adenosine is an efficient and safe treatment for paroxysmal supraventricular tachycardia in the whole pediatric age group including neonates and infants.
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Whereas the diagnosis of community-acquired pneumonia usually is straightforward, in many cases the exact etiology is difficult or impossible to determine. The clinician must have a management strategy for this illness which is not dependent upon precise microbiological diagnosis in each case. Therefore, understanding of the spectrum of community-acquired pneumonias and awareness of the possible pathogens in specific clinical settings is crucial for the choice of the most appropriate antimicrobial therapy. The factors influencing prognosis of community-acquired pneumonia are important for the decision as to which patients should be hospitalized.