Schweizerische medizinische Wochenschrift最新文献

Since the publication of the DCCT results, intensive insulin treatment, including continuous subcutaneous insulin infusion (CSII), has been considered one of the best methods for near-normal insulin delivery. The development of new, robust and easily programmable insulin pumps has led to readier acceptance of this therapy by physicians and patients. In clinical trials, CSII was found to be superior to multiple daily injection regimens in many cases. Patients with unsatisfactory glucose control, frequent hypoglycaemic events, and otherwise uncontrollable morning rises of blood glucose may in particular benefit from insulin pump therapy. Glucose control can even be improved in CSII if insulin lispro is used instead of regular human insulin, as demonstrated in many clinical investigations. Possible side effects of CSII are increased risk of ketoacidosis (e.g. in the case of catheter occlusion) and side effects at the infusion site. Since the successful development of devices for continuous glucose monitoring, the development of closed-loop systems has become more and more the focus of current clinical and technological research.

The benefits of oral prophylaxis for neutropenia have remained controversial up to now. We evaluated retrospectively the effect of antibiotic prophylaxis with ciprofloxacin and penicillin on the prevention of bacterial infections in 112 cases of prolonged neutropenia in adult patients treated for haematological malignancies. 41 patients received prophylaxis between December 1993 and November 1994 while 71 patients did not receive prophylaxis between December 1994 and November 1995. There were no significant differences between groups in age, sex, type or stage of haemopathy, type of chemotherapy and duration of neutropenia. The antibiotic prophylaxis reduced the number of overall infections (p = 0.05) and the number of gram-negative bacteraemias (p = 0.02). The median time to the onset of fever, the duration of fever, the duration of antibiotic treatment, the duration of hospitalization or admission to the intensive care unit, the number of serious complications or death were not influenced by antibiotic prophylaxis. The prophylaxis did not reduce the overall incidence of bacteraemia, of clinically documented infections or of fever of unknown origin. This retrospective study confirms that oral prophylaxis with ciprofloxacin and penicillin decreases the incidence of infections and, in particular, of gram-negative bacteraemia, but does not modify the overall morbidity and mortality in our patients. In view of the risk of emergence of bacterial resistance, these data do not support the routine use of oral antibiotic prophylaxis in neutropenic patients with haematological malignancies.

Failure of a unipolar pacemaker system due to subcutaneous emphysema is a rare but potentially life-threatening complication after implantation. We report on a pacemaker dysfunction observed three days after implantation in a 91-year-old patient following development of marked subcutaneous emphysema. Function was immediately restored following application of pressure bandages and the condition resolved within a few days.

Whipple's disease has been diagnosed more frequently in recent years as a consequence of better awareness and of improved diagnostic tools. The number of case reports of Whipple's disease without gastrointestinal symptoms and without histological lesions of the intestinal mucosa is increasing. Therefore, the traditional perception of this disease as well as the methods for its diagnosis need to be revised. We report on 2 patients with Whipple's disease who had systemic inflammatory reactions but neither gastrointestinal symptoms nor an abnormal duodenal histology. Whipple's disease was diagnosed on the basis of extraintestinal tissue histology (lymph node, vertebral body) and by polymerase chain reaction, and was treated successfully with antibiotics. Recommendations for diagnostic procedure in Whipple's disease with both typical and atypical clinical presentation are discussed.

Anisakis simplex, a fish parasite of the nematode family, typically infects marine mammals such as whales, dolphins and seals. Human anisakiasis, which is acquired by eating raw or insufficiently heated fish or squid, has gained world-wide importance. Infestation with living larvae caused by eating parasitised fish results in acute upper abdominal pain, nausea and vomiting and may be confused with acute abdomen due to appendicitis and other inflammatory abdominal disorders. Extraintestinal organ manifestations are rare. Endoscopically, inflammation, oedema, erosions and ulcerations may be found. The parasite can been found in up to 50% of patients. Histologically, an eosinophilic inflammation is typical. Acute anisakiasis may be prevented by thorough cooking or deep-freezing the parasitised fish for at least 48 h. IgG-antibodies specific for Anisakis simplex are thought to represent an immunological host reaction against parasitic antigens. More recently, allergic reactions to Anisakis ingestion or exposure, such as urticaria, anaphylaxis and even occupational asthma, have been reported. These allergic reactions may also occur when the fish has been properly cooked, and hence these allergens are thought to be heat-stable. Such cases may be diagnosed by skin tests and the determination of specific Anisakis-IgE. However, the specificity of IgE is low, since they may also be present in exposed asymptomatic individuals. Since the eliciting allergens are temperature-stable, prophylactic dietetic measures are indicated. We report a case from Switzerland acquired during a holiday in Portugal. The patient suffered from recurrent dysphagia and urticaria, and histologically eosinophilic oesophagitis was found. IgG-antibodies and a positive skin prick test to Anisakis simplex support its aetiologic role for the symptoms.

The incidence of allergic reactions to nuts, seeds and grains is increasing. Reactions to nuts are typically observed as part of a pollen-associated food syndrome (oral allergy syndrome). Nevertheless, anaphylactic reactions such as shock with lethal outcome may occur. With the increasing use and consumption of eastern and Asian cuisine, with foodstuffs such as sesame, paranuts or cashew nuts, these allergies are more frequent than they were formerly. Peanut allergy has become an epidemic problem in the United States. In this article allergic reactions to nuts, seeds and grains are discussed. Illustrative cases are presented.

In Switzerland, unlike other countries, allergic reactions to ants are a rare phenomenon when compared to the well known allergies to bee and wasp venom. In this report we present a series of case reports and a review of the different types of allergy to ants. Due to increased travel and heterogeneity of the population, we have observed several patients with sensitisation or allergy to the venom of imported fire ants (Solenopsis), a species of ant found in the Americas. Furthermore, allergic reactions to bites of the mound-building wood ant (Formica rufa), whose habitat is Central and Northern Europe, have been documented. Whereas reactions to fire ants can be life-threatening, reactions to mound-building wood ants have led to marked local reactions and in 2 cases to dyspnoea and wheezing. These reactions could be due either to primary sensitisation to ant venom or cross-reactivity in the presence of an allergy to wasp venom. Evaluation of patients presenting with a potential ant venom allergy includes a detailed personal history, skin testing and determination of specific IgE. However, to date only extracts from fire ants are commercially available for diagnostic tests. In the light of our observations we assume cross-reactivity between the venoms of fire ants and mound-building wood ants, and it therefore seems appropriate to use fire ant diagnostics in determining sensitisation to mound-building wood ants. In patients with severe fire ant-venom allergy we recommend desensitisation by immunotherapy, whereas in patients presenting with minor allergic reactions, e.g. after bites by mound-building wood ants, we provide the patients with emergency medication. Since current knowledge of ant allergies in Europe is limited, further studies are warranted.