Schweizerische medizinische Wochenschrift最新文献

We aimed in 186 patients with obstructive sleep apnoea, consecutively treated with nasal CPAP between January 1990 and December 1997, to evaluate compliance with nCPAP therapy and to explore factors influencing compliance. At 3 to 6 months (K1), 1 to 2 years (K2) and more than 3 years (K3) patients were reexamined regarding clinical conditions, the mean time of nCPAP usage per night, nCPAP pressure, and body mass index (BMI). The regularly conducted controls consisted of checking mask fitting, polygraphy with automatic pressure titration and once, mostly at K1, polysomnography. Compliance with nCPAP was considered to be sufficient more than 4 hours of usage per night. At K1, 9 patients had stopped therapy, 5 had moved away, 6 had changed therapy, 6 had died, and 41 had not been treated long enough to have a follow-up at K1. Thus we were able to reexamine 119 patients with ongoing nCPAP therapy. We found no correlation between indices of severeness of sleep apnoea (apnoea/hypopnea index, mean low of night time oxygen saturation, nCPAP pressure, and BMI) and compliance. At K1 87 patients (73%) had sufficient nCPAP compliance. All of them showed sufficient compliance at K2 and K3 too. We conclude that a sufficient compliance at an initial control implies sufficient compliance later on. 32 patients (27%) showed insufficient compliance at K1. Of this group 41% (13 patients) improved compliance at K2. This result underlines the value of a second instruction in nCPAP therapy when patient compliance was lacking initially.

Phaeochromocytoma is a rare tumour which produces a variety of symptoms. The most important factor is to think of the diagnosis, and there are many biochemical and pharmacological tests as well as radiological procedures to confirm it. Once the phaeochromocytoma is localised, it should, if possible, be removed. Surgery is the treatment of choice. In 1972 Ross described the diagnosis and therapy as "think of it, confirm it, find it and remove it". Today, 28 years later, this paper reviews the diagnosis and therapy of phaeochromocytoma under these key headings.

Mortality and morbidity from injuries in the adolescent population is substantial in Switzerland as all over the world. The estimation of morbidity from injuries is difficult and depends on the design of the study. Little information is available on morbidity between ages 12 and 15. The Health Behaviour in School-Aged Children (HBSC) study is an international survey based on a self-administered questionnaire for which the Swiss Institute for Prevention of Alcohol and Drug Problems (SIPA) is responsible in Switzerland. 7196 schoolchildren aged 12 to 15 participated in the 1998 survey. Questions covered subjects such as health and health behaviour. A few questions covered injuries, with reference to frequency, context and consequences. 45.3% of adolescents have been treated at least once by a nurse or a doctor for an injury during the past 12 months. It can be deduced that nearly 149,000 adolescents aged between 12 and 15 are injured in more than 260,000 accidents in Switzerland. The rate of injury is 793 per 1000 adolescents per year. Furthermore, one adolescent out of ten injures himself three times or more per year. In conclusion, morbidity due to injuries in adolescents aged 12 to 15 in Switzerland is therefore considerable. This study demonstrates the high prevalence of repeated injuries in adolescents.

Helicobacter pylori plays a key role in the aetiology of peptic ulcer, gastric cancer and gastric MALT-lymphoma. Based on a number of reports, a possible relationship of Helicobacter pylori infection to a variety of different dermatoses has been suggested, including urticaria, rosacea, acne-rosacea, atopic dermatitis, alopecia areata, Sjögren's syndrome, Schönlein-Henoch purpura, and Sweet syndrome. Larger case-control studies, however, do not confirm this relationship. Therefore, Helicobacter pylori eradication therapy cannot be generally recommended in these dermatoses.

The average lifespan has increased considerably in our society. Since the skin represents the most visible organ of ageing, there is increasing interest in the physiology and treatment of wrinkles, elastosis and senile xerosis. Cutaneous ageing is a complex phenomenon consisting of genetically determined intrinsic ageing and extrinsic ageing, the latter due to sun exposure, cigarette smoking and exposure to irritants. A number of biological changes can be found during the cutaneous ageing process, including decrease of epidermal, dermal and subcutaneous cellular components and changes in the immune system. Treatment modalities include the use of emollients in the treatment of senile xerosis, and topical retinoic and glycolic acid preparations, chemical peels, botulinum, collagen and hyaluronic acid injections, dermabrasion, CO2, and Nd:Yag laser resurfacing in the treatment of wrinkles.

Detection of Cryptosporidium parvum is not routinely done in laboratories of clinical microbiology and there is no obligation to communicate isolations of this pathogen to health authorities. For these reasons, frequency of cryptosporidiosis and sources of infection are only poorly known in Switzerland. To obtain more concise information in this field, feces from 5179 hospitalized and 1256 ambulatory patients with suspected gastrointestinal infections were screened for Cryptosporidium spp. over the period of one year in two laboratories. In toto, 13 patients with cryptosporidiosis were detected which results a frequency of 0.2%. Furthermore, it was shown by a projection that about 340 cases of cryptosporidiosis have to expected yearly in Switzerland, resulting an estimated morbidity of 4.85 cases per 100,000 persons. With regard to risk factors, the available patient data did not allow solid statistical conclusions. However, known risk factors such as immunosuppression, travelling abroad (33.3%) and contact to symptomatic persons were unquestionably demonstrated. Oysters, raw milk and cream from raw milk had to be strongly taken into consideration as food vehicles of transmission. Tap water from municipal nets has not to be considered as relevant source of sporadic infections. The obtained data indicate that cryptosporidiosis is a disease of low epidemiological significance in Switzerland. To a great extent, cryptosporidiosis could be prevented by best known measures of personal hygiene, avoiding certain raw food-stuffs and being aware of safe catering on travels.