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The literature describing medical aspects on sauna bathing is briefly reviewed. The circulatory effects of heating and subsequent cooling related to sauna bath differ with age, underlying medical condition and use of drugs. The circulatory changes may often be beneficial but can sometimes prove dangerous. More than 2000 sauna bathers were followed for around 20 years in a Finnish population study. The investigators have recently reported health benefits of abundant sauna use for individuals concerning hypertension, ischemic heart disease, dementia and certain pulmonary diseases. Others have recommended the use of sauna for patients with heart failure. Fatal events in sauna are very uncommon and often linked to the use of alcohol, to ischemic heart disease and to bathing alone. Medical conditions in which sauna bathing should be avoided are shortly reviewed. Further studies are urgently needed for illustration of the possible benefit of sauna bath at different medical conditions.

The trigger mechanism of paroxysmal atrial fibrillation is usually an atrial ectopic beat originating in the muscular sleeves of the pulmonary veins. These and other origins of the trigger mechanisms can be explored with electroanatomical mapping technique. Once identified, the trigger mechanism may be abolished by using the catheter ablation technique to cure the arrhythmia. We present the results for two patients with trigger mechanisms of different origin whose arrhythmia has been cured using the focal ablation technique.

Fluoroquinolone-resistance is a growing international problem. Warnings have earlier been issued concerning the risk of resistance development due to excessive fluoroquinolone prescription. The development of resistance among E. coli strains isolated from primary care patients with UTI is now apparent in Sweden. So far the majority of these strains manifest only low-level resistance. However, in view of the risk of high-level resistance developing among these strains further exposed to fluoroquinolones, it is important to think twice before prescribing these drugs.

This study was designed to investigate the development of antibiotic resistance in Swedish H pylori isolated 1990-96. A total of 415 isolates collected from 10 clinical microbiology laboratories were examined. Three different methods of susceptibility testing were compared: agar dilution, the E-test and disc diffusion. None of the isolates was resistant to ampicillin or tetracycline, but approximately 30 per cent were resistant to metronidazole. An increase in resistance to clarithromycin was noted during 1996 (9% resistant strains), though the significance of this finding needs further investigation. The comparison of susceptibility tests suggested disc diffusion to be of doubtful value, but the E-test to be appropriate for testing H pylori. However, the number of isolates resistant to metronidazole was higher with the E-test than with agar dilution. The value of testing susceptibility to metronidazole is discussed.

Streptococcus pneumoniae infections belong to the leading worldwide causes of illness and death among young children, people with underlying debilitating medical conditions, and the elderly. Following early documentation of infections due to pneumococcal strains with reduced penicillin susceptibility in Australia in 1967, and of infections due to penicillin-resistant strains in South Africa in 1978, pneumococcal resistance to penicillin and other antibiotics has progressed rapidly and is now a global problem. In Sweden, notification of the occurrence of pneumococci with a minimum inhibitory concentration (MIC) > or = 0.5 mg/L for penicillin G (PcG) has been mandatory for general practitioners (GPs) and clinical microbiological laboratories since 1 January 1996. In 1996, 1,057 cases of infection by such pneumococci were reported by microbiological laboratories, but only 262 cases by GPs. With a view to minimising the impact of pneumococci with reduced penicillin susceptibility in Sweden, the National Board of Health and Welfare set up a working group of experts in November 1994. To reduce the transmission of such bacteria in the community, the working group introduced a control programme which includes the isolation of day-care children under six years of age carrying pneumococci with PcG-MICs > or = 0.5 mg/L. An enquiry among the 25 regional centres for infectious disease control in the country to ascertain compliance in the different counties of Sweden showed the programme to have been adhered to in a majority of counties, although many had chosen alternative measures to deal with the problem.