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In a retrospective study we analyzed the clinical and blood chemical data of 12 patients with severe tropical malaria in the intensive care units of the University Hospital Zurich and the Stadtspital Triemli, Zurich, between 1991 and 1994. None of the 12 patients had been exposed to malaria before or had taken drugs for chemoprophylaxis. 7 patients survived, 5 died from complications of malaria. According to the criteria of severe tropical malaria defined by the WHO, the following pathological clinical and blood chemical parameters were noted on admission: cerebral coma (2/12); blood hemoglobin < 5 g/dl (0/12), < 8 g/dl (2/12); serum creatinine > 265 mumol/l (3/12); blood glucose < 2.2 mmol/l (0.12); circulatory collapse/shock (0/12); bleeding/signs of disseminated intravascular coagulation in laboratory tests (4/12); acidosis with pH < 7.25 (1/12). Further signs of severe tropical malaria were: hyperparasitemia > 5% (9/12); qualitative and quantitative disturbances of consciousness (6/12); thrombocytopenia < 30 x 10(9)/l (9/12); hyponatremia 125-135 mmol/l (9/12), < 125 mmol/l (2/12); rhabdomyolysis with creatine kinase > 1000 U/l (4/12). The basic treatment consisted of parenteral quinine hydrochloride in all patients; doxycycline was added in 8 cases, clindamycin in 3. Adjuvant therapy with desferrioxamin was given in 3 cases. 6 patients had exchange transfusions. Parasitemia cleared in all patients within 5 to 6 days. Later in the course, 5 patients developed acute respiratory distress syndrome, 6 required hemofiltration due to oliguria, and one became comatose.(ABSTRACT TRUNCATED AT 250 WORDS)

A review of the literature shows that condoms offer good protection against HIV infection and other sexually transmitted diseases. A series of in vitro experiments demonstrate that quality condoms made of latex are impermeable to HIV. In addition, more than 30 in vivo studies confirm that condoms are highly effective in preventing the transmission of HIV. Condom breakage or slippage is relatively uncommon (1-5%). Most condom failure probably results from incorrect or inconsistent usage. Failures may be minimized by increasing experience, choice of quality condoms and by strictly following instructions for use.

The endstage in a patient suffering from acute myeloid leukemia secondary to myelodysplastic syndrome was characterized by bleedings, anemia, pain in the upper abdomen and ascites. At autopsy the radicles of the portal veins were occluded by leukemic infiltrates and fibrosis. These lesions block the perfusion of the liver presinusoidally and, together with the anemia (hypoalbuminemia), result in ascites resistant to all therapy.

In the last few years, the treatment of HIV infection has advanced considerably due to the development of active antiretroviral compounds. Many substances with different mechanisms of action show strong activity against HIV in vitro and many of them are now under clinical investigation. But immense effort is needed to develop a clinically effective and tolerable drug for daily use from a substance active in vitro. Presently, zidovudine is the only drug that can be used for the treatment of HIV infection outside of clinical studies. The efficacy of zidovudine was demonstrated in patients with symptomatic HIV infection as well as in patients with advanced asymptomatic disease. The clinical signs of efficacy are significantly delayed progression of HIV infection and lower frequency of opportunistic infections, with decreased severity. It is evident that zidovudine does not cure the HIV infection. In Switzerland treatment with zidovudine is evaluated by post-marketing surveillance (PMS). All patients on zidovudine are seen periodically in the hospitals with a specialized division for HIV infection. Clinical and laboratory follow-ups are recorded. Until the beginning of October 1990, 1171 patients with symptomatic HIV infection have been treated with zidovudine in the setting of this PMS. 62% of all registered patients are currently receiving zidovudine. 20% died of AIDS. 15% of all patients received at least one blood transfusion. Hematotoxicity is the most frequent and serious side effect of zidovudine and can require definitive termination of therapy. The side effects are dose related and occur more severely in patients with advanced disease. The ideal dosage of zidovudine has not yet been defined. Recently published studies showed efficacy with doses as low as 500 mg/d. Consequently, patients in Switzerland receive 10 mg zidovudine/kg body weight as the maximum dose, divided into two or more single daily doses. Patients with asymptomatic HIV infection are regularly treated with 500 mg/d. Zidovudine-intolerant patients with symptomatic HIV infection can currently enter a controlled clinical trial of antiretroviral therapy with dideoxyinosine (ddI), which has a different spectrum of side effects but is only minimally toxic to bone marrow.

Recent case reports emphasize that HIV infection may influence the clinical picture, course and therapy of concurrent syphilis. The case of a 32-year-old patient with coinfection by T. pallidum and HIV is presented. Clinical presentation, diagnostic procedures and therapy are discussed in the light of the current literature. False negative serologic tests for syphilis in HIV-patients raise the question of the sensitivity of these tests in HIV infection. Efficacy of therapy for neurosyphilis and the value of CSF (cerebrospinal fluid) examination in early syphilis are of increased importance in HIV infection. Current guidelines for diagnosis and therapy of syphilis in HIV patients are outlined.

Observations of 12 patients with AIDS at this institution from March 1981 to April 1984 are reported. Ten patients were homosexuals and two were bisexual. The majority had travelled abroad (USA, Haiti) and reported multiple anonymous sexual contracts. Eleven patients reported symptoms and signs, of 2-12 months' duration, frequently seen in pre-AIDS: fatigue (10), weight loss (10), diarrhea (7), night sweats (5), fever (4), and generalized lymphadenopathy (1). Laboratory studies showed anemia (10), lymphopenia (9), leukopenia (7), decreased T-helper/T-suppressor ratio (10) and cutaneous anergy to multiple skin-test antigens (9). P. carinii pneumonia was diagnosed in three patients, P. carinii pneumonia and Kaposi's sarcoma in one patient and Kaposi's sarcoma in six patients. Another patient had a chronic mucocutaneous infection with herpes simplex and another an intestinal cryptosporidiosis and Kaposi's sarcoma. Alpha-A-interferon was used to treat patients with Kaposi's sarcoma and three patients with limited disease showed a favorable response. Six patients with advanced disease died.

Thrombocytopenia is a relatively frequent hematological complication of HIV (human immunodeficiency virus) infection. The incidence of thrombocytopenia in a cohort of 359 homo- or bisexual men with HIV infection was 3%, while it was 9% in a cohort of 321 HIV positive persons with a history of intravenous drug abuse. We followed 42 thrombocytopenic patients prospectively to study the clinical significance of thrombocytopenia in these patients. Thrombocytopenia was significantly more severe in intravenous drug abusers than in homo- or bisexual men: 52% of the drug abusers had thrombocyte counts below 10,000/mm3, compared with only 9% of the homo- or bisexual men. Symptoms of bleeding, almost always harmless skin or mucosal bleeding, were found in 45% of patients with a history of intravenous drug abuse and in 18% of the homo- or bisexual men. Life-threatening bleeding episodes did not occur during a median observation period of approximately one year. Prednisone was the most commonly used drug in symptomatic thrombocytopenia and had demonstrable effect only while being administered. After medication was stopped the thrombocyte counts usually fell to pretreatment values. Our findings suggest that therapy of HIV-associated thrombocytopenia should be reserved for severely symptomatic patients, particularly since this symptom of HIV infection rarely causes serious complications and we do not know the influence of drugs such as corticosteroids on the progression rate of HIV-infection.

The treatment of anaerobic infections still poses various problems for the physician. The authors deal with the surgical, but also, and in particular, the antibiotic treatment of anaerobic infections. The in-vitro activities, indications, side effects and dosage recommendations of the first choice (clindamycin, metronidazole and ornidazole, cefoxitin, penicillin G) and second choice antibiotics (chloramphenicol, ticarcillin) are discussed.

A report is presented on a 53-year-old patient with endocarditis caused by Lactobacillus casei 9 years after prosthetic replacement of the aortic valve with a Björk-Shiley graft. In spite of a delay of about 6 weeks before therapy was started (due to difficulties in identifying the causative agent), treatment with a combination of penicillin G and gentamicin was effective and replacement of the artificial valve was not necessary. Seven months after cessation of therapy the patient is still free of symptoms. No other report of conservatively managed endocarditis due to lactobacilli and involving a prosthetic valve was found in the literature accessible to our group.

The multiplicity of antibiotics currently available for the treatment of bacterial infections in outpatients and inpatients has led to considerable confusion and uncertainty in recent years. An attempt is made to establish indications for the use of the various groups of antibiotics, paying due regard to cost as well as other aspects. This means drawing a distinction between the respective needs of out- and inpatients. In treating outpatients, where resistance is less of a problem than in hospitals, use is made principally of oral substances. In the light of current knowledge the vast majority of bacterial infections occurring in ambulatory practice can be optimally treated with pyrimidine-sulfonamide combinations, penicillins, tetracyclines and erythromycin. In contrast, the range of broad-spectrum antibiotics administered in hospitals, for the most part parenterally, in infections of a life-threatening nature or due to organisms exhibiting multiple resistance, is quite different. Most important are the more recent penicillins and cephalosporins and the aminoglycosides. By combining betalactam antibiotics with aminoglycosides and attempt is made to extend the therapeutic spectrum and intensify antibacterial activity. A conclusive judgement on the therapeutic differences between the more recent penicillins and cephalosporins as single-substance therapy or in combination with aminoglycosides is not yet possible at present. There seems good reason, however, to combine the more recent penicillins with aminoglycosides in infections in which enterococci, pseudomonas and anaerobic bacteria are also involved. In infections in which there is a possibility of Klebsiella involvement or in which penicillin allergy or penicillin resistance is present, treatment tends to be a combination of cephalosporins and aminoglycosides.

The authors describe the indications for quantitative susceptibility tests and also the methods themselves (agar dilution, macrodilution, combination tests, tests for beta-lactamase production). This study forms part of a series on susceptibility methods which started with a paper on disk susceptibility testing (this journal, 1984; 114: 1079-1086).

Transcobalamin II(TC II) is an essential transport protein for vitamin B12 in blood. TC II can be split up into isoproteins by polyacrylamide gel electrophoresis. Family studies are compatible with a genetic polymorphism of TC II and a five allele system. Screening of TC II isoprotein patterns in about 1000 individuals yielded two unusual TC II variants: The first case was a black female with severe megaloblastic anemia since infancy. Her TC II was elevated and bound B12, but displayed markedly diminished functional capacity to transfer radioactive cyanocobalamin in cellular systems. Comparison of this patient's TC II isoprotein pattern with known variants showed a distinct difference in electrophoretic mobility, indicating the presence of a sixth allele. The second patient, also presenting with pernicious anemia-like symptoms, was found to possess an unusual TC II variant with reduced TC II serum levels. Corresponding variants were also observed in the patient's asymptomatic children. Thus, abnormal TC II variants probably causing megaloblastic anemias both correlated with unusual isoprotein patterns.

The present concepts of antibiotic therapy in bacterial endocarditis are reviewed. Recommendations for the treatment of the most frequent pathogens -- streptococci of the viridans group, enterococci, staphylococci -- and for unknown organisms are presented. Antimicrobial therapy directed against gramnegative organisms, especially of the pseudomonas group, and against anaerobic bacteria is briefly discussed. The presence of renal impairment calls for adjustment of dosage; relevant nomograms are published in the literature. Probenecid may be added to the antibiotic therapy to increase serum levels of penicillins and some cephalosporins, though a major drawback is its side effects. Clinical experience teaches that every recrudescence of bacterial endocarditis adds permanent damage to an already impaired valve. Hence it is of utmost importance that the aim of antimicrobial therapy should be a 100% cure.

The results of 115 bronchoscopic examinations and one autopsy in 105 adults with HIV-infection and pulmonary complications are presented. Whereas 51.7% of the events were caused by Pneumocystis carinii pneumonia (PCP), nonspecific interstitial pneumonitis (NIP) without evidence of an infectious or neoplastic condition was the second most frequent diagnosis in 14 patients (12.1%), four of whom exhibited features of lymphocytic interstitial pneumonia (LIP). The clinical, radiological and prognostic aspects of NIP/LIP, which are very similar to those of PCP, and the possible pathogenesis are discussed. The importance of an adequate diagnostic pulmonary workup is emphasized. We suggest classifying patients with NIP/LIP as stage IV E (CDC) and evaluating the efficacy of a treatment with azidothymidine (AZT) in a controlled clinical study.

Pseudomembranous colitis (PMC) caused by a toxin produced by Clostridium difficile is described in the literature as a severe diarrheal disease with a high mortality rate. A case which tends to absolve PMC from this reputation is reported involving an outpatient who developed well documented PMC subsequent to ampicillin therapy but required no treatment. The number of unreported cases of antibiotic-associated colitis with and without pseudomembrane formation is probably very high, since only severe cases of diarrhea are thoroughly investigated. In a chronological literature review an attempt is made to update the nomenclature of antibiotic-associated colitis. There are recent reports of a connection between the Clostridium difficile toxin and the chronic inflammatory "non-bacterial" intestinal diseases ulcerative colitis and Crohn's disease. The authors finally consider whether in cases of antibiotic-associated diarrhea efforts should be made to isolate Clostridium difficile and/or demonstrate the presence of its toxin, for the purposes of prognosis and therapy.

Current recommendations for antibiotic prophylaxis of bacterial endocarditis include oral amoxycillin, and erythromycin or clindamycin for the penicillin-allergic patient. The authors report the serum concentrations and side effects which may be expected after the recommended oral doses of these compounds. Single doses of 3 g amoxycillin and 600 mg clindamycin, and two doses of erythromycin (1.5 g and 0.5 g 6 h apart) were administered in a random sequence to each of 12 volunteers. After administration, peak serum concentrations of amoxycillin and clindamycin were 27 mg/l and 5.5 mg/l respectively. Amoxycillin was eliminated more rapidly than clindamycin. Serum concentrations of erythromycin were below the sensitivity limit of the assay (0.03 mg/l) in 3 volunteers at 1 h and in 2 at 2 h. The mean peak serum concentrations was 3.1 mg/l. Peak levels were associated with gastrointestinal side effects such as nausea, abdominal cramps and vomiting. The implications of these findings are discussed with respect to use of these antibiotics for the prophylaxis of bacterial endocarditis.

145 consecutive patients scheduled for a cardiac catheterization were enrolled in a prospective double-blind randomized study to determine the incidence of bacteremia during and following catheterization and the usefulness of antibiotic prophylaxis with cefazolin versus placebo during this procedure. Four blood cultures were taken from each patient to evaluate the incidence of bacteremia vs. contamination. 15 of 296 (5.07%) and 11 of 284 (3.8%) cultures yielded bacteria in the placebo group (74 patients) and in the cefazolin-group (71 patients) respectively. Statistical analysis revealed no significant difference between the groups. These results, together with the spectrum of the organisms isolated and the clinical and laboratory findings, suggest that the isolation of bacteria was due rather to contamination than the result of bacteremia. It is concluded that antibiotic prophylaxis in patients undergoing cardiac catheterization is unnecessary and not indicated.

The results of an 11-month pilot study of surveillance of nosocomial infections are reported. Prospective surveillance was performed by daily examination of the microbiology reports and daily visits by the infection control nurse to the ward for the review of charts and Kardex of all patients for detection of "infection clues". Work sheets were used to collect all data during the daily rounds. Infection rates were calculated by dividing the the total number of hospital-acquired infections by the total number of discharges during the surveillance period. Active surveillance was performed for 6 months in the surgical intensive care unit (SCIU), 5 months in the surgical ward (SW) and 9 months in the medical ward (MW). Of 1527 patients discharged from these wards, nosocomial infections developed in 158 patients (10.4%). The overall infection rate was 14% (214 nosocomial infections). The infection rate varied greatly from ward to ward due to different patient populations, invasive procedures and severity of underlying diseases. Incidence infection rates were 42.5% for the SICU, 19.6% for the SW and 4.1% for the MW. The major sites affected were surgical wounds (42%), urinary tract (23%), respiratory tract (19%) and bloodstream (8%). The major etiologic agents associated with these nosocomial infections were E. coli, Pseudomonas aeruginosa, enterococci and Staphylococcus aureus. Conclusions drawn from the results of surveillance are discussed. The major benefits of an effective surveillance program for nosocomial infections are (a) estimates of the endemic levels of nosocomial infection, (b) identification of the nosocomial pathogens commonly encountered within a given institution, (c) identification of risk factors and (d) prompt recognition of epidemics. These data provide the necessary basis for an effective infection control program.

To survey antibiotic use in general practice, questionnaires were sent to 1160 practitioners in the Canton of Zurich. 510 (44%) were returned. Antibiotics had been administered for respiratory tract infections in 60% and urinary tract infections in 20% of cases. Sulfamethoxazole/trimethoprim, followed by oral penicillin, tetracycline and aminopenicillin were prescribed most frequently. Adverse side effects do not appear to be significant in general practice. Guidelines for the diagnosis and treatment of the most frequent infectious diseases occurring in an outpatient population are presented.

A new multiple risk factor intervention program, combining a comprehensive, stepwise and health education-based approach, was tested in an outpatient setting. In the first 47 patients (aged 17-55, referred by their physicians) total cardiovascular risk (estimated by Framingham index) was reduced within the first 12 months by an average of 32.5%. This improvement derived from significant reductions in all major risk factors. These findings demonstrate the feasibility and potential, yet unexploited, benefit of a more comprehensive risk factor, approach in general medical practice.

At the end of December 1984, 8246 AIDS cases had been reported in the United States, and 762 cases in Europe. The main risk groups are homosexual and bisexual men (73%), heterosexual i.v. drug addicts (17%) and Haitians (4%). AIDS is diagnosed in patients meeting the clinical criteria of the CDC surveillance definition (opportunistic infections and/or Kaposi's sarcoma). The prevalence of HTLV-III antibodies in risk groups is high, its prognostic significance still controversial. Laboratory methods to determine the more relevant circulating viral proteins or the whole virus are now being developed. Limited studies to evaluate the possibility of reconstituting the immune system of AIDS patients with interleukin-2 and gamma-interferon have proved unsuccessful. successful. Several new drugs with possible antiviral properties are now being evaluated in first clinical trials.

Hepatic manifestations of acquired immunodeficiency syndrome (AIDS) were analyzed in 76 consecutive patients. Serological markers of hepatitis B were found in 84%. All instances of biopsy-proven chronic hepatitis were associated with delta infection. One patient with intestinal cryptosporidiosis had a severe cholestasis. In the majority of patients histological examination of the liver revealed non-specific alterations, but in several cases was diagnostic of mycobacterial disease. The study of liver disease in HIV-infected patients could lead to a better understanding of diseases such as chronic hepatitis B and sclerosing cholangitis.

A case of Rhodococcus equi pneumonia associated with septicemia and metastatic brain abscess in an HIV-infected male is presented. Clinical findings and the diagnostic and therapeutic approach are discussed. Cavitating pulmonary disease was rapidly improved by six-week combined oral and parenteral antibiotic treatment. However, pulmonary relapse and brain abscess were documented after one month. Therapy with ceftriaxone, ciprofloxacin and cotrimoxazole on an outpatient basis again led to clinical and radiological improvement after four weeks. Surgical resection of localized processes should be considered early, and prolonged antibiotic therapy over months is recommended.

In 1979 a three-month multicentre study of resistance of bacteria isolated from humans and animals was carried out in Switzerland with the participation of 22 institutes and laboratories. A total of 23,852 antibiograms were evaluated concerning the following bacteria: Escherichia coi, Klebsiella pneumoniae, Salmonella sp., Serratia marcescens, Proteus (indole-negative), Proteus (indole-positive), Pseudomonas aeruginosa, Staphylococcus aureus, and enterococci (streptococci of Group D). 95.5% of the strains were isolated from human material, almost half being isolated from urine. The remaining 4.5% were obtained from animal material, more than half being isolated from the milk of cows with mastitis. Although the various institutes and laboratories did not use a uniform, standardized method, the results are closely in line with those of similar studies carried out earlier in Switzerland, Germany, Austria and the USA. No pronounced trend in the direction of increased resistance is observable.

The occurrence of visceral leishmaniasis is rare in Switzerland. We discovered this disturbance in a patient while on immunosuppressive medication for mycosis fungoides. Untreated visceral leishmaniasis has a high mortality. It can be expected that more cases will be observed in patients treated with immunosuppressive drugs or in patients with the acquired immunodeficiency syndrome (AIDS).

This paper describes the standardized Kirby-Bauer disc method for the determination of antibacterial susceptibility, also including choice of antimicrobials, interpretation of results, problems with particular bacteria, and quality control. Only a meticulous adherence to the details of the method will guarantee reliable results.

53 individuals negative for anti-HIV by screening test and 79 individuals positive for anti-HIV were prospectively surveyed for clinical progression and by quantitatively measuring anti-p24 (antibodies against an HIV core protein), anti-gp41 (antibodies against an HIV surface protein) and HIV-(p24) antigen. The patients were classified into four categories of HIV-markers: 1. Anti-p24 in high concentrations, HIV-Ag negative, 2. anti-p24 in high concentrations, HIV-Ag positive (most often transitory only), 3. anti-p24 absent/deficient, HIV-Ag negative and 4. anti-p24 absent/deficient and HIV-AG positive. Within a minimum of 18 months, 4 of the 53 (8%) initially anti-HIV negative individuals contracted HIV infection. 17 of the 79 (22%) initially anti-HIV positive individuals showed disease progression. 8 of the patients in category 4 already had AIDS when entering the study, and 3 of the 6 (5%) remaining patients of this category developed AIDS. Amongst the 19 patients in the third category 2 individuals (11%) developed AIDS and in a further 5 (26%) individuals the disease progressed but in no case to AIDS. None of the patients of the categories 1 and 2 developed AIDS but 2 of the 10 (20%) individuals in the second category and 3 of the 29 (10%) in the first category showed disease progression but not to AIDS. In conclusion, the quantitative measurement of anti-p24 and of HIV-Ag affords prognostic pointers for the clinical outcome of HIV infection.

Indications, side effects, dosage and pharmacokinetic properties of gentamicin, tobramycin, sisomicin, kanamycin and amikacin are reviewed. Different aspects of aminoglycoside antibiotics in combination with beta-lactam antibiotics are briefly discussed. Finally, the indications for the assay of serum levels of aminoglycosides are listed. Gentamicin, tobramycin and sisomicin appear to be very similar with regard to in vitro performance, clinical efficacy and pharmacology. Ototoxic and nephrotoxic side effects are observed - in decreasing order of frequency - with sisomicin, gentamicin and tobramycin. The advantage of amikacin is its stability against enzymatic inactivation, which should make it an agent of first choice against aminoglycoside-resistant gram-negative bacteria.

To gain information on antibiotics usage in the daily practice of ENT specialists in the Zürich area, 64 questionnaires were distributed at the beginning of 1980. Approximately half the questionnaires were returned. The results of antibiotics usage in common ENT infections are summarized and their bacteriological spectrum is discussed in the light of the literature. Finally, the spectrum of activity and daily cost of various antibiotics are discussed and an appropriate antibiotic therapy is recommended.

Sera of 100 healthy homosexual men were tested for antibodies to AIDS virus HTLV-III. Significant differences were found between 45 seropositive and 55 seronegative men, such as a higher number of sexual partners per year, more contacts with AIDS patients, positive serological markers for syphilis, and reduced skin reaction after intradermal application of 7 recall antigens.

In patients with HIV infection, secondary prophylaxis should prevent HIV-associated complications caused by opportunistic infections and psychosocial morbidity. This overview presents the possibilities of chemoprophylaxis and control of transmission to prevent opportunistic and non-opportunistic infections. Indications for immunization in HIV-positive patients are also discussed. Both medical treatment and psychological and social support are equally important for optimal patient care.

Two patients developed signs of LAV/HTLV-III infection one and two years respectively after a blood transfusion. The leading symptom in one patient was generalized lymphadenopathy, while the other patient presented with Candida stomatitis. In both cases, blood transfusions administered in 1983 were found to be the only possible source of infection; one blood donor of each patient was anti-LAV/HTLV-III positive. Family members and sexual partners of the two were negative for antibodies against LAV/HTLV-III. Our findings document the first two cases of LAV/HTLV-III associated disease most probably related to blood transfusions in Switzerland.

A study was performed to analyse antibiotic usage in a surgical department, with the object of providing a basis for improving antibiotic policies. Patients admitted to the Department of Surgery (134 beds) of the Waid Community Hospital in Zürich (400 beds) after 1st Jan. 1979, and who received antibiotics during the period between 22 Jan. and 31 March were included in the study (n = 154). Daily chartreview provided all necessary information on clinical, diagnostic and therapeutic data of the patients included. 154 patients had 178 treatment courses which were reviewed according to guidelines proposed by the "audits of Antimicrobial Usage" (1977) and categorized as follows: I. agree with indication, appropriate choice and use of antibiotics; II. same, inappropriate choice and/or use of antibiotics; III. administration not justified. 83 of 178 treatment courses were prophylactic and 95 therapeutic. 58% of the prophylactic treatment courses were not justified (cat. III), and the remaining 42% were inappropriate in choice and/or use of antibiotics (cat. II). 41% of therapeutic treatment courses were adequate (cat. I), 43% were indicated, but these patients would have benefited from a more appropriate choice and/or use of antibiotics (cat. II), and in 16% the use of an antibiotic was not justified (cat. III). These results are compared with similar studies. On the basis of our findings, appropriate propositions for improvement of antibiotic policies are discussed.

Antibiotic prophylaxis for gynecologic and obstetric surgery is reviewed. Numerous clinical studies conducted under controlled conditions have established and confirmed the beneficial effects of short term (preferentially single-dose) perioperative antibiotic prophylaxis for various procedures. Cephalosporins, particularly of the first generation, have been used extensively despite the fact that their antimicrobial spectrum does not include all pathogens recovered from postsurgical infections in gynecology. Perioperative antibiotic prophylaxis is effective in reducing the incidence of infection-related morbidity and mortality of vaginal hysterectomy, especially in premenopausal women. This protective effect is less pronounced for abdominal hysterectomy. The incidence of postoperative infections at a particular hospital should be used as guideline as to whether antibiotic prophylaxis will be beneficial or not for these patients. The same applies to C-sections, for which antibiotic prophylaxis should be administered to high risk patients only, such as secondary C-section or patients with severe underlying diseases. The optimal timing appears to be after cord clamping, which prevents transfer of the antibiotic to the newborn.

Acquired immune deficiency syndrome (AIDS) has been etiologically linked with the human T-cell lymphotropic virus HTLV-III. In a study on the prevalence of antibodies to this virus in Switzerland, sera from 941 individuals were collected in 5 major urban areas (Basel, Berne, Geneva, Lausanne and Zurich) in 1983 and 1984. All sera were tested by ELISA and the majority also by Western blot. We found an antibody prevalence of 100% among 22 cases of AIDS, of 94% among 48 cases of AIDS-related complex (ARC), and of 57% among 14 homosexual contacts of AIDS patients. Among 55 sera collected from i.v. drug addicts in 1984, 53% were positive, whereas the rate had been 36% among 103 sera collected in 1983. The rate was 19% among 227 sera collected from asymptomatic active homosexuals in 1984, against 10% among 40 sera collected in 1983. 8% positives were found among 98 patients with various types of viral hepatitis. In addition, 4% of 84 sera of individuals from Equatorial Africa were positive. No positives were found among 15 sera of individuals from other African regions, among 32 sera of persons from various regions of Asia, and among 203 Swiss blood donors. These results demonstrate the high and increasing rate of HTLV-III infection among groups at risk for AIDS, and suggest that HTLV-III-related diseases will be a serious problem in the years ahead.

Eleven patients with non-Hodgkin's lymphoma and three patients with Hodgkin's disease were observed among 876 anti-HIV-positive subjects attending the AIDS clinic at the University Hospital, Zurich, Switzerland. Compared to the general population this represents a 50-fold (95% confidence limits: 25-90) increased risk of non-Hodgkin's lymphoma and an 11.4-fold (2.3-33) increased risk for Hodgkin's disease in anti-HIV-positive men. High malignancy, advanced stage of disease at the time of diagnosis, and extranodal localization are characteristic of non-Hodgkin's lymphoma in AIDS patients, which carries a poor prognosis. However, remissions and prolonged disease-free survival are possible in individual cases. Only one opportunistic infection was observed during 92 months of treatment and observation using a mild chemotherapeutic regimen (m-BACOD). Less myelosuppressive chemotherapeutic schedules appear to be more beneficial than aggressive regimens in anti-HIV-positive patients due to the lower incidence of opportunistic infections.