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

The susceptibility of 2196 fresh clinical isolates to twelve different oral compounds was assessed in five Swiss microbiology institutions during summer 1992. A standardized microdilution system including all other material necessary was employed to assess the antibacterial activity of penicillin G, ampicillin, ampicillin + sulbactam, amoxycillin + clavulanic acid, cefadroxil, cephalexin, cefaclor, cefuroxime, cefetamet, doxycycline, erythromycin and clindamycin. The aminopenicillins (including the beta-lactamase inhibitor combinations) were highly active against the streptococci, in combination with a beta-lactamase inhibitor they covered the majority of the bla+ E. coli and Proteus mirabilis and between 60 to 80% of the Klebsiella spp. and Proteus vulgaris isolates. All the cephalosporins exhibited good activity against the streptococci, they were active against Gram-negative fermentative rods to a varying degree. Cefetamet was also active against many cefaclor and cefuroxime-resistant isolates. A considerable part of the species studied exhibited resistance to doxycycline; the observed resistance of S. agalactia, P. mirabilis, and Morganella morganii agreed with previous findings. Most of the Streptococcus spp. were inhibited by erythromycin and clindamycin. There were only single penicillin resistant S. pneumoniae isolates in the five Swiss centers. Taking account of the above particulars the epidemiology of antimicrobial resistance in Switzerland can be considered satisfactory.

Osteoporosis is a major public health problem because of increasing prevalence and the cost of related morbidity, especially fractures of the spine and hip. The perimenopausal evaluation of risk patients by assessment of clinical risk factors and bone-mass measurements are used to select patients for prevention of postmenopausal and age-associated bone loss. The value of bone-mass for prediction of fracture-risk and the clinical significance of bone-densitometry for patient management is reviewed. Four essential clinical indications for bone mass assessment are discussed.

Interpersonal therapy of depression (IPT) has proven to be very effective in a comparative study of therapeutic modalities for the treatment of depression. It reflects contemporary research on the etiology and the nosology of depressive disorders and offers a multifactorial treatment concept. Specifically, IPT integrates aspects of biological vulnerability for depression with the psychosocial context of a person. Disturbed social relations are seen as possible causes as well as consequences of depressive disorders. IPT has the goal to reduce depressive symptomatology and to improve interpersonal functioning. It emphasizes the structured diagnosis of depression in order to help the patient to better understand his condition. Symptoms are then related to his or her interpersonal context. Therapy sessions deal with four problem areas: Grief over loss, interpersonal disputes, role transitions, and interpersonal deficits. When necessary, prescribing medication is an integral part of the therapeutic procedure. The article gives an overview of the literature and the therapeutic strategies of IPT which seems especially effective for the treatment of mild to moderate depressions in primary care.

Schoenlein-Henoch purpura is characterized clinically by palpable purpura, mainly on the legs, with varying degrees of gastrointestinal, articular and renal involvement. Renal involvement is often more severe in the adult than in children and it often determines the outcome of the disease. Schoenlein-Henoch purpura is also characterized by an IgA-vasculitis, which may be triggered by several non-specific antigenic factors. Its pathogenesis is still unclear, but a dysfunction of the IgA immune system has been demonstrated. We discuss the anatomo-clinical, therapeutic and etiopathogenic aspects of this syndrome according to today's knowledge.

In the canton of Vaud general practitioners and internists from the private sector play a great role in the care for addict patients. Their interventions may also contribute to a decrease of risk factors as they work with families, children and adolescents. To help them to do better and in order to have more collaborators in this field, the University Department of Adult Psychiatry of Lausanne and the Department of Public Health of Vaud have developed a two-year program: the Program of Prevention and Physicians Postgraduate Training in the field of Addiction. The paper presents the different ways of interventions being selected, the first result concerning the program's activities, including a few remarks, and the role of the general practitioner.

The measures taken by the National Government in 1991 against drug problems in Switzerland included new therapeutic experimentation; among others, it mentioned trials with diversified prescription of narcotics (including injectable heroin, morphine and methadone as well as smokable heroin and cocaine) to heroin-dependent persons with severe health and/or social problems. The number of persons receiving heroin is limited to 250, for a period not exceeding the end of 1996. The trials have to respond to scientific criteria of evaluation as well as to standards of comprehensive care. Research questions concern the feasibility, the efficacy and the cost effectiveness of trials in comparison with usual methadone maintenance programs. First trials started in Zurich, others are planned in Basle, Berne, Fribourg, Olten, Schaffhausen, Thun and Zug.

Referring to theoretical and empirical examples taken from psychiatry, psychology and sociology, this paper first clarifies the dimensions and application of concepts such as 'natural recovery' and 'spontaneous remission'. In order to illustrate the general development of research in the area of therapy free drug remission from a purely quantitative approach to a qualitative, ethnographic one, two studies are referred to: the classic Vietnam veteran study done by Robins and a longitudinal analysis of a network of cocaine users. This is also supplemented by the latest results from Germany. Next, the empirical results of the ongoing spontaneous remitter follow-up study from the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA) are presented. The analysis of the gender specific processes involved in the long-term stabilization of heroin autoremission, taking the support of social surroundings into consideration, shows the following: independent of gender, a high stability of autoremission was determined four years after the initial survey. In only three out of thirty cases has there been a relapse since the first interview. This result confirms the general significance of social support during the autoremission phase for both gender groups. Measured against dominant role expectations, it can be said that most of the men have successfully reintegrated into society. Women, on the other hand, seem to deviate more strongly from traditional professional and family roles. This might be due to particularly longlasting social sanctions during their former addiction. Finally, some practical consequences for the drug treatment system drawn from autoremission research are discussed as well as some drug and social policy conditions favorable to autoremission.

In 1992 a campaign was initiated to bring to attention new ways for drug prevention in adolescents for health promotion in addicts and for therapy and follow-up of ex-addicts. By this broad base the Swiss Health Authority and the Federal Sports Institute at Magglingen together with partners from Swiss sport and addiction-care organizations try to contribute to a reduction of drug-related problems in Switzerland. The following article bases mainly on experiences with long-term therapy of the 'Drogenhilfe Aebihus' in Leubringen.