Showing papers in "Revue médicale suisse in 2013"

Continuous renal replacement therapy for acute kidney injury

Abstract: Acute kidney injury is common in critical illness and associated with important morbidity and mortality. Continuous renal replacement therapy (CRRT) enables physicians to safely and efficiently control associated metabolic and fluid balance disorders. The insertion of a large central venous catheter is required, which can be associated with mechanical and infectious complications. CRRT requires anticoagulation, which currently relies on heparin in most cases although citrate could become a standard in a near future. The choice of the substitution fluid depends on the clinical situation. A dose of 25 ml/kg/h is currently recommended.

[Recurrent Clostridium difficile infections: the importance of the intestinal microbiota].

Abstract: Clostridium difficile infections (CDI) represent 20-30% of diarrhea caused by antibiotics and relapse in more than 25% of cases after treatment with metronidazole or vancomycin. Given the high prevalence of CDI and the significant rate of recurrence despite successful initial treatment, CDI therapy represents a real challenge. A better understanding of the intestinal microbiota and its role in CDI opens the way to promising new therapeutic approaches, such as fecal transplantation. The studies published to date, although few, conclude a certain effectiveness of fecal transplantation in recurrent CDI. Further studies are needed to confirm its effectiveness, determine the long-term consequences as well as good administration practices.

Acquired long QT syndrome

Abstract: The long QT syndrome may be acquired or genetically determined. The syndrome is characterized by a prolonged QT interval and is associated with an increased risk of cardiac arrhythmia such as a torsade de pointe and death. Electrolytes disorders such as hypomagnesemia and hypokaliemia and several drugs may increase the risk to develop a long QT syndrome. The epidemiology, the aetiology, the diagnostic approach as well as the management options of an acquired QT prolongation is discussed and reviewed herein.

Unicompartmental knee replacement

Abstract: Unicompartmental knee arthroplasties (UKA) have been created to treat primary unicompartmental knee arthritis. They are indicated in case of lower-limb deformity due to unicompartmental arthritis, but not to treat unicompartmental arthritis due to extra-articular deformity. Early failures are do to ligamentar problems or to surgical technical errors. Late failures as wear or loosening are undoubtely delayed by adequate surgical indication and technique. Indeed the 10 years PUC survival is 90%. Patient age is not a selection criteria because both young (50-60 years old) and old (> 80 years old) patients may benefit of a UKA. UKA allows a young patient to continue low-impact sports and octagenarians will benefit of the lower morbidity of UKA surgery.

The crisis of the middle class

Abstract: Feel lonely? What about reading books? Book is one of the greatest friends to accompany while in your lonely time. When you have no friends and activities somewhere and sometimes, reading book can be a great choice. This is not only for spending the time, it will increase the knowledge. Of course the b=benefits to take will relate to what kind of book that you are reading. And now, we will concern you to try reading crisis of the middle class as one of the reading material to finish quickly.

Simulation in obstetrics

Abstract: Obstetrical emergencies may represent extremely critical situations with potential dramatic maternal and neonatal consequences. These situations should be managed by an effective and experienced multidisciplinary staff. Simulation allows a regular and repeated practice of these situations with no risk to patient safety and the possibility to analyse participants' performances in a group. This review describes different obstetrical simulation methods and summarizes the evidence for its efficiency in obstetric practice.

[Control of an outbreak of vancomycin-resistant enterococci in several hospitals of western Switzerland].

Abstract: An outbreak of vancomycin-resistant enterococci (VRE) occurred in 2011 in several hospitals of western Switzerland. Given that VRE can spread rapidly within hospitals and due to the potential transfer of resistance genes to other nosocomial pathogens like MRSA, stringent control measures were implemented. Excellent coordination of control measures between partner healthcare settings was successful in stopping the outbreak.

[Schizophrenia: genes, environment and neurodevelopment].

Abstract: Psychoses are complex diseases resulting from the interaction between genetic vulnerability factors and various environmental risk factors during the brain development and leading to the emergence of the clinical phenotype at the end of adolescence. Among the mechanisms involved, a redox imbalance plays an important role, inducing oxidative stress damaging to developing neurons. As a consequence, the excitatory/inhibitory balance in cortex and the pathways connecting brain areas are both impaired. Childhood and adolescence appear as critical periods of vulnerability for deleterious environmental insults. Antioxidants, applied during the environmental impacts, should allow preventing these impairments as well as their clinical consequences.

Management of renal anemia in 2013

Abstract: Anemia occurs frequently in patients with chronic kidney disease (CKD), especially in the later stages, and the main etiologies are decreased production of erythropoietin (EPO) as well as iron and vitamin deficiencies. For these reasons, it is essential to detect anemia in patients with CKD and to investigate the etiology. If anemia (Hb < 100 g/l) persists after substitution of deficiencies, treatment with recombinant human erythropoietin (rHuEPO) should be considered. New guidelines (KDIGO - August 2012) have just been published by the National Kidney Foundation (NKF) for the management of anemia in patients with renal failure. This article reviews the principles and innovations in management in 2013.

[Sulfonamide allergy and cross-reactivity].

Abstract: Beside beta-lactams, sulfonamide antibiotics are among the most common causes of drug allergy. Hypersensitivity to sulfonamides including IgE-mediated immediate, delayed cell-mediated mechanisms, and severe life-threatening reactions are still incompletely understood. Unfounded concerns of cross-reactivity between sulfonamide antibiotics and a variety of non-antibiotic-containing sulfonamide drugs render pharmacotherapy unnecessarily difficult. Here, the history, clinical manifestations, diagnosis and treatment of sulfonamide allergy are briefly reviewed.

[Urinary incontinence: neither men nor women should be forgotten].

Abstract: The prevalence of urinary incontinence is higher in women, but up to 40% of elderly men suffer from it. It is very important for care givers to search actively for this problem, because only half of the patients, mostly men, will seek help specifically for this symptom. The patients, who do not ask for help, mostly women, think that urinary incontinence is a normal problem while getting old and think that there is no specific treatment for it. Urinary incontinence has an important impact on physical and mental health and has a high economic cost. Men with urinary incontinence are less well taken in charge than women up to the use of absorbent pads, which they partly fix up themselves.

Recherche d'informations sur internet : quels sont les usages des femmes enceintes ?

Abstract: Dans la litterature, les recours a internet par les patients sont interpretes soit comme une ressource favorisant leur autonomie, soit comme une source de perturbation dans la relation medecin-patient. Analysant 50 entretiens menes avec des femmes enceintes, cet article vise a decrire les differents usages d’internet realises au cours de la grossesse. Certaines femmes aspirent avant tout a partager leur experience a travers leurs recours a internet. D’autres y cherchent des informations specialisees, par curiosite, pour completer les informations transmises dans les consultations ou, plus rarement, pour pallier un manque dans l’echange avec les professionnels. Les recours a internet par les patients etant amenes a se developper a l’avenir, il est important que les professionnels prennent en compte ces differents usages dans leurs pratiques.

[Information seeking on the internet: what information are pregnant women seeking?].

Abstract: In the literature, uses of the internet by patients are interpreted either as a resource supporting their autonomy, or as a source of perturbation in the doctor-patient relationship. Analysing 50 interviews with pregnant women, this article aims at describing the different uses made during pregnancy. Some women mostly aim at sharing their experience in their use of internet. Others are looking for specialised information, by curiosity, to complement the information received in medical visits or, more rarely, as a result of a lack of information in their exchanges with professionals. Uses of internet by patients will develop in the future and it is important that professionals take into account these different forms of internet use in their practices.

[Tularemia, an emerging disease in Switzerland].

Abstract: Tularemia is an infection caused by Francisella tularensis. This zoonose is transmitted to human through contact with infected animals or by vectors such as ticks. It has been a rare disease in Switzerland until recently, but its incidence is increasing. The clinical manifestations of tularemia are diverse and the ulcero-glandular disease is the most common form. It presents with an ulcerative lesion at the site of inoculation and regional lymphadenopathy which can be massive. Diagnosis is based on culture, PCR or serology with antibody titer rise approximately 2 weeks after the onset of illness. Antibiotics with clinical efficacy include doxycycline, fluoroquinolones and aminoglycosides.

[What are patients' attitudes towards generic drugs? The example of metformin].

Abstract: The success of cost containment with generic drugs is based on consumer's willingness to accept substitution. This investigation reveals 3 major themes that can explain attitudes of patients towards generics: 1) personal beliefs and knowledge (coming from the media issues, family, friends) are fragmented and sometimes erroneous, with a background of suspicion on the quality of the generics; 2) relation with the prescriber (indirectly pharmacist) is central to build up patient's trust; suspicious professionals generate an anxious patient; 3) previous experience from the consumer with generics. Starting from patients' experiences and beliefs allows to anticipate their resistance to the generic and to adapt drug prescription choices.

Hyperlactatemia and lactic acidosis in the critically ill patient

Abstract: Hyperlactatemia is associated with an ominous prognosis in critical illness and must be rapidly detected. Lactate is produced by glycolysis through reduction of pyruvate, itself oxidized in the mitochondria. It is transported to the liver and converted to glucose through gluconeogenesis (Cori's cycle). Hyperlactatemia can result from excessive production or reduced clearance. Excess production can occur in aerobic conditions, following an increase in pyruvate generation, or in anaerobic conditions, due to impaired pyruvate oxidation. Reduced lactate clearance occurs as a result of liver hypoperfusion or hepatic failure. Lactate/pyruvate ratio, as well as the concomitant existence of metabolic acidosis (lactic acidosis), help distinguish the different mechanisms leading to hyperlactatemia, which are reviewed in detail in this article.

Diagnosis of non dermatophyte onychomycosis ant its relevance for treatment

Abstract: PCR methods are reliable and suitable to in situ identify dermatophytes, yeasts and non dermatophyte moulds (NDM) in onychomycosis. Onychomycosis insensitive to standard treatment with topical agents as well as with oral terbinafine or itraconazole revealed Fusarium spp., Acremonium spp. and Aspergillus spp. as infectious agents. However, NDM onychomycosis could be efficiently cured using topical amphotericin B. In conclusion, correct fungal species identification is important in onychomycoses in order to prescribe adequate treatments since dermatophytes and moulds have different sensitivities to antifungal drugs.

[Dialysis and ecology: can we do better in the future?].

Abstract: Development of dialysis has saved the lives of many patients. However, haemodialysis and peritoneal dialysis are very demanding in resources such as water and electricity, and generate a large amount of waste. In this article, we will review the environmental aspects of dialysis. Different solutions will be discussed, such as recycling of water discharged during reverse osmosis, the integration of solar energy, recycling of waste plastics, and the use of other techniques such as sorbent dialysis. In a world where natural resources are precious and where global warming is a major problem, it is important that not only dialysis, but all branches of medicine become more attentive to ecology.

Return to sport after anterior cruciate ligament reconstruction

Abstract: Despite continuous advances in techniques for anterior cruciate ligament reconstruction (ACLR), return to play (RTP) after surgery remains a challenge. More than one-third of the patients are unable to return to their preinjury sport level, for most because of a fear to sustain another injury. And when a RTP is attempted, up to 20% will tear their graft and a similar % will sustain an ACL tear on the opposite side. We believe that these failures result from an incomplete recovery. Based on a literature review and on our experience, we suggest 6 objective criteria to allow a safer RTP. They rely on laxity, strength, neuromuscular function, and psychological evaluations. Rehabilitation after ACLR should focus on the deficits identified by these tests and on they specific needs of the sport that the athlete plans to return to.

Prothèses unicompartimentales du genou

Abstract: Unicompartmental knee arthroplasties (UKA) have been created to treat primary unicompartmental knee arthritis. They are indicated in case of lower-limb deformity due to unicompartmental arthritis, but not to treat unicompartmental arthritis due to extra-articular deformity. Early failures are do to ligamentar problems or to surgical technical errors. Late failures as wear or loosening are undoubtely delayed by adequate surgical indication and technique. Indeed the 10 years PUC survival is 90%. Patient age is not a selection criteria because both young (50-60 years old) and old (> 80 years old) patients may benefit of a UKA. UKA allows a young patient to continue low-impact sports and octagenarians will benefit of the lower morbidity of UKA surgery.

[Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures].

Abstract: For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.

Pseudarthrosis of the long bones

Abstract: 5 to 10% of all fractures present with a delayed union, whereas 1 to 5% progress to a nonunion, which can be defined as a fracture older than 6 months and lacks any potential to heal without any further intervention. Different fracture and patient related risk factors exist, and the management of a nonunion needs a thorough clinical, radiological and biological workup to classify them in one of the two main categories, the viable nonunions that need essentially more stability, usually by a more rigid fixation, and the non-viable nonunions that need essentially a biological stimulation by decortication and bone grafting. This treatment still remains the first choice with bony healing obtained in 85 to 95% of cases, but it also comes along with certain risks, and some valuable alternatives exist if chosen on the basis of rigid criteria.

[Consensus 2012--diagnosis and treatment of patients with dementia in Switzerland].

Abstract: The 2012 Swiss consensus paper on diagnosis and management of patients suffering from dementia resulted from the work of an expert panel who met on March 23d to 25th in Luzem. Based on a literature review, panel members wrote a first draft that was subsequently circulated among multiple dementia experts in Switzerland. After adaptation and revisions according to comments, all consulted dementia specialists and panel members fully endorse the consensus content. The conference was financed by the Swiss Alzheimer Forum.

[Surgical site infection: risk factors, prevention, diagnosis and treatment].

Abstract: Surgical site infection comprises the cutaneous tissues until the intraabdominal or pleural cavity The infectious risk depends on the degree of bacterial contamination, the general conditions of the patient and procedure-related factors The causal microbes originate from the flora of the skin or the mucosal surfaces that have been touched during the operation Superficial non-complicated infections are treated locally However, an infected surgical wound can be the top of a deep infection Infections with foreign material underneath deserve particular attention Empiric antibiotic therapy is prohibited in these cases Treatment is normally a combination of surgical debridement and specific antimicrobial therapy

An update on celiac disease

Abstract: Celiac disease is a well-known entity in pediatrics and pediatric gastroenterology that is now also frequently encountered in the adult population. Apart from typical symptoms, celiac disease can present with a wide range of manifestations that are sometimes atypical, scarce or purely extraintestinal. Serologic and genetic testing are useful tools in case of low clinical probability in the early diagnostic algorithm. Upper gastrointestinal endoscopy remains the mainstay to confirm the diagnosis especially in atypical clinical presentations. Complications are rare but can be severe. Although gluten-free diet often leads to complete recovery, compliance is not universal and alternative treatment strategies are under investigation.