Search

Our hospitals are suffering from an increasing run of "minor emergency cases". Those are simple medical or surgical ailments that could be taken care of by a general practitioner's office in a competent and cost efficient way. Because of the ever growing problem of a shortage of general practitioners, those patients are directly going to the emergency room of our hospitals, where they are usually seen by a young and yet unexperienced doctor, who is ordering an expensive battery of tests even for minor troubles of his or her wellbeing. It was shown that emergency room crowding has a negative impact on the quality of patient care. The establishment of an office run by a general practitioner within the hospital emergency room may result in a certain relief of the situation.

On December 26, 2004 the second largest earthquake ever seismographically registered occurred in South-East Asia. It had a magnitude of 9.3 on Richter's scale and its epicentre was located on sea ground 160 km West of Banda Aceh, the capital of the province of Aceh on the island of Sumatra. The earthquake resulted in a tsunami which almost completely destroyed the city of Banda Aceh. Its death toll on the island of Sumatra was 168,000. The Swiss Humanitarian Aid Unit was deployed within a few days after the catastrophe with an advance team, which had to evaluate the need for supplies and personal in Banda Aceh. In close collaboration with relief forces of the Australian armed forces the team was able to deliver efficient medical and technical support. The most prevalent medical problems were: (1) Tsunami associated aspiration pneumonia; (2) Infected wounds of lower extremities; (3) Open bone fractures of lower extremities; (4) Tetanus infection.

Introduction: Media reports about Norovirus outbreaks, especially in hospitals and nursing homes, have accumulated in the past years. The reasons for this increasing problem are manifold: resistance against common disinfectants, a high level of contagion (a dose of less than 100 particles may be infective); variability of the virus-genome documented by polymerase chain reaction-studies, as well as further factors concerning modern life-style. The following study describes and analyses a Norovirus outbreak in the SRO-Hospital Langenthal from November 25, 2003, to December 31, 2003., Patients and Methods: The case definition included sudden vomiting and diarrhoea, abdominal cramps, fever below 38.5 degrees C and recovery after 48 hours. Stool cultures were taken and tested for bacteria (Campylobacter jejuni, salmonella and shigella species) and rotaviruses. Stool and vomit specimens were then tested using Real Time Polymerase Chain Reaction (RT-PCR) for noroviruses using different primer sets. Epidemiological data were gained such as transmission modus from person-to-person or food-borne., Results: A total of 77 persons were affected by the viral disease. Two incidence-peaks of gastroenteritis were noted. The first peak happened in the geriatric ward and the second in the geographically distinct department of internal medicine. The existence of a new norovirus strain of genogroup II/4 has been confirmed by the CDC Enteric Viruses Branch in Atlanta, GA. The measures to be taken are pointed out., Conclusions: A norovirus gastroenteritis outbreak of such intensity and extent as described had not thus far occurred in the hospital's history. The strains newly found by sequencing are associated with genogroup II/4. This genogroup caused a striking increase of gastroenteritis outbreaks in Europe in the year 2002 including atypical spring and summer peaks. This new variant is supposed to be more virulent and environmentally more stable than previous strains [21]. Preventive measures that are in agreement with the published guidelines were taken before the viral pathogen was identified by RT-PCR. The obvious emerging problem of norovirus infections in our society and the economic data analysing the costs caused by lost bed days and staff absence make epidemiological investigation of outbreaks and application of molecular tests more important. They are the basis for determining transmission routes and characterising the different strains in order to improve preventive strategies.

Background: Many cancer patients use alternative therapies in addition to conventional treatment. In a survey among such patients, we assessed the prevalence of and the motivation for alternative therapy use in a rural area of Switzerland., Methods: From 1st February to 30th November 2001, we interviewed 108 patients treated in the oncology outpatient clinic of the Langenthal District General Hospital, Switzerland, using a structured questionnaire. 77% of the patients were female. 49% of the patients (i.e., 64% of the female patients) suffered from breast cancer., Results: 42 (39%) of all patients had used an alternative therapy in addition to conventional treatment at least once. Mistletoe preparations were by far the most popular with a prevalence of 74%. Homeopathy (24%) and cancer diets (12%) were used less often. 79% of the patients seeking help from alternative treatment informed their treating oncologist and/or medical practitioner accordingly. 57% of the doctors encouraged their patients to continue the alternative treatment, none discouraged the patient to do so. The main reasons for the use of alternative therapy were: the desire to feel more hopeful (83%); "to do as much as possible myself to cure the disease" (83%); and to harness mental energy (62%). Only 19% of the patients hoped to be cured of cancer by alternative therapy., Conclusions: The motivation to seek help from alternative treatment is not based on a distrust of conventional care. Maintaining hope and taking an active role in self-care are the main stimuli for using alternative medicine.

We describe a case of Niemann-Pick disease type B. A 13-year-old female adolescent of Turkish origin suffered from abdominal pain for several months, finally leading to hospitalisation. The investigations revealed splenomegaly and interstitial pneumopathy. The bone marrow contained giant foam cells typical of Niemann-Pick disease. Enzymatic analysis of a fibroblast culture confirmed the diagnosis of Niemann-Pick disease type B, with reduced activity of acid sphingomyelinase. Niemann-Pick disease is an inherited autosomal recessive lysosomal storage disorder of sphingolipids, resulting in an accumulation of sphingomyelin in the cells of the reticulo-histiocytic system due to an enzymatic defect. In Niemann-Pick disease type B the spleen and lung are the main organs affected. At present no treatment exists for this disorder.

A 65 year old female developed right thoracic pain, productive cough and fever four weeks after hemicolectomy because of a cancer of the sigmoid. In spite of antibiotic treatment the condition of the patient deteriorated and she was admitted to the hospital with pneumonia of an upper lobe. Chest X-ray visualized prominent proximal pulmonary arteries. Progressive respiratory failure developed and blood gas analysis revealed hypocapnic hypoxemia. The patient had to be intubated and ventilated mechanically. Later, left arm blood pressure measurements could no longer be taken and the radial pulse was missing. Thereafter, an ischemic syndrome of the right leg developed. Embolectomy from the superficial femoral artery was carried out the same day. The patient died five days later. Autopsy revealed an almost complete occlusion of the pulmonary arteries. The organization of thrombotic material indicated recurrence. Emboli were also found in the systemic circulation. A large patent foramen ovale together with signs of pulmonary arterial hypertension are indicative of paradoxical thromboembolism.

Invasive group A streptococcus (GAS) infections are emerging diseases; however, person-to-person transmission of invasive GAS producing life-threatening infection has been observed rarely. We report a small intrafamilial cluster of life-threatening GAS infections. A previously healthy 47-year-old father developed necrotizing fasciitis of the neck. Two days later, his 16-year-old daughter developed streptococcal angina, pneumonia, and pleural empyema. Both patients had signs of streptococcal toxic shock syndrome. Pulsed field gel electrophoresis revealed that the M6 strains of GAS isolated from the father and daughter had identical patterns. Cases of person-to-person transmission of invasive GAS infection reported in the literature are also reviewed.

The QBC Autoread System is based on fully automatic, electro-optical linear measurements of the discrete layers of packed blood cells in a microhematocrite tube. The layering results from differing cell densities during high-speed centrifugation. The determination of hemoglobin, hematocrit, leucocytes, platelets and of the percentual share of granulocytes and lymphocytes/monocytes with the QBC Autoread System was evaluated concerning reliability and precision in comparison with the conventional analytical methods. We used a Coulter Counter System and the manual differentiation of the stained blood smears as reference methods. The evaluation of the first 400 blood samples showed a close correlation for all hematological parameters examined, but no significant deviation relative to the reference methods. Only 83 of totally 1000 (8.3%) examined venous blood samples could not be evaluated completely by the QBC Autoread System. For the analysis of very pathological cell populations, especially of hematological oncological diseases, the QBC System is not qualified. The extreme portability, the quick practicability and the good accordance with the conventional analytical methods make the QBC Autoread System a qualified screening method for practice and emergency laboratories.

A 15-year-old boy with poststreptococcal glomerulonephritis is described. During his recovery from nephritis he acquired varicella, which led to a flare-up of the glomerulonephritis with a transitory increase in blood pressure, body weight, and serum creatinine. We can only speculate on the pathogenetic mechanism of the flare-up. The glomerulonephritis may have been reactivated by immune complexes containing varicella antigens, or the varicella infection may have provoked immunologic changes leading to a new burst of immune complexes containing streptococcal antigens.

A 38-year-old female patient with acute tubulo-interstitial nephritis and uveitis (TINU syndrome) is described. The cause of this rare disease is unknown; most patients affected are adolescent females. Serologic investigations in the patient reported point to a possible etiologic role of Chlamydia infection in this disease.

A 46-year-old patient was referred because of recurring bouts of abdominal colics, petechiae and an accompanying nephropathy. The clinical setting pointed towards a cryoglobulinemia, proved by serum cryoprecipitation and electrophoresis and classified as type II. The primary disease was a low-grade non-Hodgkin lymphoma involving bone-marrow and liver. A renal biopsy showed a proliferative glomerulonephritis. Treatment with prednisone and chlorambucil led to improvement of renal function, and the patient became asymptomatic.