Swiss medical weekly
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Transthoracic echocardiography is an easily accessible, non-invasive imaging procedure for evaluation and follow-up of critically ill patients. It is particularly helpful in evaluating patients with thoracic pain, low-output syndrome or heart murmur, and has prognostic value in acute myocardial infarction. It makes a diagnostic contribution in 60 to 90% of cases, and has therapeutic implications in 50 to 65%. New ultrasound technics are briefly discussed.
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Cerebral malaria is the most important manifestation of severe Plasmodium falciparum infection. The clinical picture in South East Asian adults differs from that in African children. The children are more likely to have abnormal brain stem reflexes, signs suggestive of cerebral herniation, and raised CSF opening pressure, and to suffer persistent neurological sequelae. ⋯ The pathophysiology of cerebral malaria may involve mechanical obstruction of the cerebral circulation by parasitized erythrocytes which have adhered to the vascular endothelium. Cytokines such as tumor necrosis factor may also contribute. The most important element of treatment is early, optimal chemotherapy with quinine, but artemisinine derivatives may prove even more effective.