Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis最新文献

The progress of surgical techniques and the development of more potent immunosuppressive drugs have increased the success rate of renal transplantation such that the quality of life for kidney transplant patients is at the present time superior to that for dialysed patients. However, both renal and extrarenal complications may develop. Acute rejection episodes are the main factor governing long-time renal survival and its treatment with reinforced immunosuppressive therapy may lead to severe infections. Surveillance of kidney transplant patients should include the thorough search for side effects of immunosuppressive therapy and potential drug interactions. Progressive loss of graft function is observed in the majority of patients. Cardiovascular complications, related to the increased incidence of hypertension and hyperlipidemia, remains the main cause of death in kidney transplant patients. Long-term immunosuppression also increases the incidence of cancer, in particular of skin cancer and lymphoma. Despite these potential complications, major efforts must be made to improve organ donation, as both on medical and economical grounds, renal transplantation appears to be the best method available for kidney function replacement.

The continuous rise in the number of patients treated for chronic renal failure is due to improved technique, demand for treatment and an increased incidence of certain renal diseases in the elderly. Preventive measures and a discussion of socio-ethical problems are needed.

Technical improvement in both, hemo- and peritoneal dialysis, has made these methods extremely safe and efficient. With an increasing number of patients entering a dialysis program for end-stage renal disease, the number of long-term dialysis patients, who will not receive a transplant for various reasons, will also increase. Modern dialysis treatment must not only keep the patient alive but has to allow for as much individual and social rehabilitation as possible. Indication, timing and predialysis preparations must be in the nephrologist's hands. However, for most patients the family's physician has been a partner and adviser during many years of a chronic disease. Therefore, he should be familiar with principles and practice of modern dialysis treatment. It is the aim of this paper to outline some basic principles of the most common dialysis modalities used today and to consider their pros and cons with respect to the patient's individual situation.

Isolated mesenteric fibromatosis is a rare form from the group of intraabdominal fibromatoses which often accompany Gardner's syndrome. It consists in a benign proliferation of fibroblasts with infiltration of muscles and fat tissue. It is diagnosed by ultrasound and CT-scans. The treatment of choice is the total surgical extirpation of the tumor. We report about a 19 year old patient with an isolated mesenteric fibromatosis following a normal pregnancy without previous surgical interventions.

The term "Necrotizing soft tissue infections" describes a group of limb- and sometimes lifethreatening infections mostly of the limbs. The necrotizing soft tissue infections are classified, depending on the involved tissue level, microbiology and clinical course: 1. primarily located in the subcutaneous level and fascia: 1.1 hemolytic streptococcal gangrene, 1.2 necrotizing fasciitis, 1.3 gram-negative, synergistic, necrotizing cellulitis, 1.4 clostridial cellulitis, 1.5 anaerobic nonclostridial-cellulitis; 2. primary located in the muscle: 2.1 clostridial myonecrosis, 2.2 streptococcal myositis. Between 1989 and 1992 17 patients with necrotizing soft tissue infections were treated at the Department of Surgery, University Hospital of Zurich. Incipient necrotizing soft tissue infections are underestimated easily due to atypical or minor initial signs. The infections may be caused by a variety of bacteria, spread rapidly and can lead to a critical condition. The surgical treatment has to be aggressive with extensive debridement of the affected areas supported by intensive care. Delayed or even omitted surgical treatment, inappropriate therapeutic concepts and incomplete debridement with compromises may have fatal consequences. Repeated debridement as well as amputation of the affected limb is justified to guarantee the patient's survival.

Complementary (or alternative) medicine has gained so much public interest that physicians have to face and discuss this new phenomenon. We are, however, already strained by trying to find an easy answer to the initial question: 'To what is this medicine complementary or an alternative?' Complementary means 'additionally'. Prior to our understanding why a complementation is necessary we must clarify what has to be complemented: Theories, methods and criteria for the goals of academic medicine have to be defined before characteristics of a complementary medicine can be outlined. According to Strapanek and McCormick extraordinary claims call for extraordinary proofs. Such claims are expressed in alternative therapeutic concepts. We have to consider whether it is justified to ask for the appropriate proofs.

We report on diagnostic and differential diagnostic considerations in the case of a 30 year old Italian woman with hypokalemic alkalosis, fatigue and muscular weakness. The symptoms were caused by a Bartter syndrome with distinctly increased renin but almost normal aldosterone levels in the serum and increased aldosterone values in the urine.