A giant exoplanet orbiting a very-low-mass star challenges planet formation models.

Surveys have shown that super-Earth and Neptune-mass exoplanets are more frequent than gas giants around low-mass stars, as predicted by the core accretion theory of planet formation. We report the discovery of a giant planet around the very-low-mass star GJ 3512, as determined by optical and near-infrared radial-velocity observations. The planet has a minimum mass of 0.46 Jupiter masses, very high for such a small host star, and an eccentric 204-day orbit. Dynamical models show that the high eccentricity is most likely due to planet-planet interactions. We use simulations to demonstrate that the GJ 3512 planetary system challenges generally accepted formation theories, and that it puts constraints on the planet accretion and migration rates. Disk instabilities may be more efficient in forming planets than previously thought.

[CVID (common variable immunodeficiency): heterogeneous clinical manifestation of the commonest symptomatic primary immunodeficiency disease]. / CVID (common variable immunodeficiency): heterogene Krankheitsmanifestation dieses häufigsten symptomatischen primären Immundefekts.

Common variable immunodeficiency is the most common symptomatic primary immunodeficiency disease. The patients typically present with a long history of respiratory tract infections, sometimes sarcoid-like lesions and in rare cases boils. Heterogeneity of initial clinical manifestations as well as insufficient knowledge of the syndrome often delay the diagnosis. However, early therapy is important to reduce infections and in particular the development of bronchiectasis. Documenting 19 cases, we discuss initial clinical manifestations, some clinical complications, diagnostic procedures and therapeutic management.

[Inhaled colistin in cystic fibrosis]. / Inhalatives Colistin bei zystischer Fibrose.

UNLABELLED: The clinical course of cystic fibrosis (CF) is characterised by chronic bronchial infection with Pseudomonas aeruginosa. Therapy with inhaled aminoglycosides was introduced to decrease the rate of infectious exacerbations and to delay pulmonary progression. However, development of resistance to aminoglycosides is frequent. Few investigations are available into the resistance profile under treatment with colistin. Antibiotic resistance to colistin was analysed in 44 adult CF patients treated with inhaled colistin. Resistance to aminoglycosides was observed in 86% of cases (38/44) before therapy and decreased to 43% (19/44) under treatment with colistin. Five patients (11%) developed polymyxin resistance. After cessation of therapy pseudomonas became sensitive to polymyxin within a few months and enabled colistin to be reintroduced. In addition, we performed a pilot study analysing the effect of inhaled colistin on the growth of pseudomonas. The number of Pseudomonas aeruginosa decreased from 16.7 million (CFU) bacteria per ml sputum to 2.9 million under therapy with colistin. There was a more than tenfold increase in bacterial counts after inhaled colistin was stopped. Genotyping revealed no change in the type of pseudomonas strains. CONCLUSION: Development of resistance to polymyxin is not rare under long-term treatment with inhaled colistin and requires temporary interruption of therapy. Sputum cultures should therefore be tested regularly for polymyxin resistance in patients treated with inhaled colistin.

[Central lung embolism in chronic interstitial pneumopathy]. / Zentrale Lungenembolie bei chronisch interstitieller Pneumopathie.

An 80 year old patient with known interstitial pneumopathy of unknown etiology was hospitalized because of acute onset and rapid deterioration of dyspnea at rest within days. A foregoing neurologic investigation including CT and EEG because of prior syncopes and cramp attacks had not revealed pathologic findings. Thorax X-ray at admission showed homogenous loss of transparency on the left side, calcified basal plaques on both sides and prominent central pulmonary vessels with jumping caliber. A punctate of the leftsided pleural effusion revealed lymphocytic exsudate, normal pH, low glucose and an elevated LDH. The patient died shortly after a collapse at a bowel visit and pulmonary embolism was suspected in accordance to results from arterial blood gas analysis, ECG and chest X-ray. Neurologic symptoms could be explained by recurrent pulmonary embolism. Pleural plaques together with the punctate suggested a malignant etiology. A mesothelioma was taken into consideration, although there were no anamnestic reports on an exposition to asbestos. Autopsy revealed almost complete central embolism of the left pulmonary artery with acute cor pulmonale thus confirming the clinical suspicion. The embolus showed components of different ages of origin. Besides bronchitic and emphysematous alteration histology of the pulmonary tissue revealed interstitial and septal fibrosis with focal tissue consolidation. In one giant cell a typical asbestos body was found (in 1 out of 10 sections). In spite of missing information on an exposition to asbestos an abnormally high exposition must be taken into consideration because of the finding of an asbestos particle in relation to the amount of tissue studied. Apart from interstitial fibrosis asbestos may also cause consolidation of pulmonary tissue. Histology of plaquelike lesions revealed mesothelioma of fibrous type. This finding supports the suspicion that a major part of the pulmonary lesions was due to exposition to asbestos.

[Inhalational antibiotic therapy in patients with cystic fibrosis and Pseudomonas infection]. / Zur inhalativen Antibiotika-Therapie bei Patienten mit zystischer Fibrose und Pseudomonas-Befall.

Treating chronic Pseudomonas infection of the bronchial tree is a very important part of the treatment strategy in patients with cystic fibrosis. There are only a few antibiotics which are effective against pseudomonas. Many of them soon lead to bacterial resistance (e.g. fluoro-quinolones). Inhaling antibiotics produces high sputum concentrations and low systemic toxicity. Tolerance is good and resistance rare. Several clinical studies, some of them doubleblind placebo controlled, have shown a positive effect of inhaled antibiotics on symptoms, on frequency of necessary i.v. therapies and also on pulmonary function. Most commonly aminoglycosides (tobramycin) and colistin, which is not yet registered in Switzerland, are used. The main indication is chronic therapy of Pseudomonas infection.

[Menstruation-associated (catamenial) pneumothorax and catamenial hemoptysis]. / Menstruations-assoziierter (catamenialer) Pneumothorax und catameniale Hämoptyse.

We report on 2 patients with catamenial pneumothorax and one patient with catamenial hemoptysis. The pathogenesis of these diseases is not clear, and intrathoracic endometriosis is often assumed. Catamenial pneumothorax is rare and differs from primary spontaneous pneumothorax in its prevalence in the fourth decade and in mainly multiparous women, its recurrent and almost exclusively right-sided occurrence within 72 hours of the beginning of menstruation, and the generally small size of the pneumothorax. About 5% of women under 50 presenting with primary pneumothorax have catamenial pneumothorax. Prevention of recurrence is difficult, as the recurrence rate is high, treatment duration is potentially long, and residual thoracic pain during menstruation is sometimes seen. The combination of medication (Gn-RH analogues, danazol, possibly hormonal contraceptive drugs or progestagens) with efficient pleurodesis (e.g. thoracoscopic talc application preferentially performed during menstruation) seems so far to be the most efficient, although no controlled studies have yet been performed. Catamenial hemoptysis is very rare and hormonal treatment alone is frequently successful in the long term. In the event of relapse, resection of the implicated endometriotic or angiomatous lesion localized by computed tomography can be performed.

Molecular approach to identifying route of transmission of tuberculosis in the community.

There is growing concern that tuberculosis is spread in Europe in the way that it is in the USA. We have used DNA "fingerprinting" in a systematic evaluation of tuberculosis cases notified in our community to uncover foci of transmission. An IS6110 probe was used to test all isolates from culture-confirmed tuberculosis cases (163 patients) notified in 1991-92 in the Canton of Berne. In total, 45 patients (27.6%), potentially linked on the basis of restriction fragment length polymorphism, were investigated epidemiologically. The largest group (n = 22) included members of a defined social group (drug addicts, homeless persons, alcoholics), from whom tuberculosis spread to the general population. A key patient developed multidrug-resistant tuberculosis during the surveillance period. This population study showed that (i) extensive transmission of Mycobacterium tuberculosis is now taking place in Europe in the same social setting as in the USA; (ii) there is definite "spillover" to the general population; (iii) the dimensions of the problem cannot be recognised easily by routine public health service activities because of the complexity of the transmission network; and (iv) multidrug-resistant tuberculosis develops in this setting.

[Diagnosis and therapy of endobronchial and tracheal hamartomas]. / Diagnose und Therapie endobronchialer und trachealer Hamartome.

Endobronchial hamartomas are a tenth as frequent as the usually asymptomatic intrapulmonary hamartomas. We report on 7 patients. 2 men and 3 women had an endobronchial hamartoma. In one patient multiple endobronchial hamartomas were found in the left upper lobe. In a 56-year-old patient with an 8-year history of shortness of breath, cough and several episodes of pneumonia and acute onset of respiratory failure, a tracheal hamartoma was diagnosed. Frequently, endobronchial hamartomas can be resected without loss of lung tissue. Laser resection is often possible and may be the treatment of choice in elderly or inoperable patients. Because of lower risk, laser resection is frequently preferred to conventional operative resection in patients with tracheal hamartomas.

[Diagnosis and therapy of pleural empyema]. / Zur Diagnose und Therapie des Pleuraempyems.

21 patients with thoracic empyema were treated at this clinic over a period of 3 years. 15 patients had metapneumonic empyema, 2 empyema associated with sepsis, and 4 postsurgical empyema. In 12 patients the underlying illness was chronic disease while 9 patients were thus far in good health. The most frequent causative pathogens were staphylococci and streptococci, together with anaerobic bacteria. One patient died of the underlying disease. Three cases of metapneumonic empyema healed completely with antibiotics only. Closed chest tube drainage with small chest tube was performed 13 times and was successful 11 times with a mean drainage duration of 13 days. Six patients underwent surgery (early decortication in 4 instances, late decortication in 2). The surgical indication was in 4 instances multilocular of the empyema which inhibited chest tube drainage, imminent loss of function in 1 case and unsuccessful drainage in a case of bronchopleural fistula in 1 instance. Apart from high-dose antibiotic therapy, earliest possible drainage is of crucial importance in the treatment of thoracic empyema. Surgery should be considered only in uncomplicated empyema if drainage is impossible for technical reasons.

[The significance of computerized tomography of the chest in the staging of bronchial carcinoma]. / Zur Bedeutung der thorakalen Computertomographie beim Staging des Bronchuskarzinoms.

The value of thoracic computed tomography in the staging of non-small cell bronchogenic carcinoma is evaluated. In 57 patients post thoracotomy and in 8 patients who had undergone mediastinoscopy, the preoperative T and N stages determined by CT were compared with the intraoperative stage. With respect to the T3 stage, 49 CT results out of a total of 57 were correct, 6 were false positive and 2 false negative. This corresponds to a sensitivity of 67% and a specificity of 88%. With respect to the N2 stage, 55 out of 65 results were correct, 8 were false positive and 2 false negative, corresponding to a sensitivity of 87% and a specificity of 84%. We conclude that in N2-negative CTs mediastinoscopy can be omitted, while in CT-positive patients histological verification appears to be necessary. The diagnosis of T3 should be carried out with caution: in doubtful cases surgical exploration is recommended.

[Diagnosis and therapy of lung abscess]. / Zur Diagnose und Therapie des Lungenabszesses.

10 patients with primary lung abscess have been treated for 2 years. The patients were predominantly middle-aged men with predisposing factors for aspiration such as, essentially, alcoholism. All patients were in a fairly good general condition. The most frequent symptom was purulent foul smelling sputum. Most abscesses were found in the dorsal segments of both lower lobes and of the right upper lobe. Bacteriological examination of abscess punctate frequently revealed anaerobic bacteria. The primary treatment in all cases was conservative, including postural drainage and longterm therapy with high dose penicillin or amoxicillin. In 9 cases this led to complete clinical and radiological recovery; only 1 patient had to be operated on because of failure of conservative therapy. Aspiration of anaerobic bacteria from the oropharynx is of prime importance in the genesis of primary lung abscess. Therapy is conservative, with penicillin as the drug of choice.

[Sodium chloride intake and supply of iodine in the Swiss population]. / Untersuchungen zum Kochsalzkonsum und zur Jodversorgung der schweizerischen Bevölkerung.

The controversial salt intake in a representative sample of the Swiss adult population was evaluated by measuring the sodium excretion in the urine of 966 adult probands of different regions in Switzerland. Prior to this study the validity of a widely used and easy method for the analysis of sodium excretion in large scale studies was investigated by determination of the quotient of sodium excretion and creatininuria in a single urine sample and the calculation of the 24-h values. The results with this method were compared to those of determination of effective sodium content in the 24-h urine samples of 43 probands. Similar mean values were demonstrated for both methods. On the other hand, only 53.5% of the individual results were between +/- 30% of the effective values. It is therefore concluded that this method is useful only for large scale studies but not for individual evaluations of sodium excretion. The mean sodium excretion was 176.2 +/- 105.9 mmol/24 h for the 966 probands. This corresponds to a daily salt intake of 10.3 +/- 6.2 g. Determination of the effective sodium excretion in 24-h urine samples of 147 probands, which differed slightly from the whole collective with regard to age and sex distribution, confirmed these data with a mean sodium excretion of 143.2 +/- 62 mmol/24 h, corresponding to a daily salt intake of 8.4 +/- 3,6 g. Iodine excretion in the 24-h urine samples of 112 probands completed the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities of gut vessels in Turner's syndrome.

We describe a 57-year-old patient with Turner's syndrome, iron deficiency anaemia and intestinal vascular abnormalities. Colonoscopy revealed 2 widely dilated, tortuous veins in the terminal ileum and several smaller ectatic veins and haemangioma-like malformations throughout the colon. Laparotomy for herniotomy showed only minimal vascular abnormalities of the serosal surface. Patients with Turner's syndrome and anaemia should be checked for these lesions by endoscopy, and conversely, in patients with such lesions, Turner's syndrome should be considered.

[Clinical data on Legionnaires' disease. Report on 8 sporadic cases of Legionella pneumonia]. / Zur Klinik der Legionellose. Bericht über 8 sporadische Fälle von Legionella-Pneumonie.

In 1978 and 1979, eight sporadic cases of Legionella pneumonia were observed in the Berne and Ticino areas of Switzerland. In all cases the diagnosis was established serologically using indirect immunofluorescence. Seroconversion was observed in five patients. In three cases initially high antibody titers decreased progressively. The clinical picture was characterized by acute onset with high fever, frequent chills, and dry cough. Occasional concomitant symptoms included muscular pains, headache, thoracic pain, dyspnea, hemoptysis, and gastrointestinal and central nervous symptoms. Laboratory findings showed markedly increased BSR as well as slightly increased WBC with a pronounced shift to the left. In all cases, X-ray examinations demonstrated extended, mainly unilateral and often remarkedly peripheral infiltrations of the lung. On the basis of the clinical course, two groups could be distinguished: (a) non-complicated cases of pneumonia with rapid improvement within 2-3 weeks; and (b) cases with a protracted sometimes severe course with persistence of the infiltrations up to 4 months and more. All patients with a protracted course suffered from concomitant symptoms. Whereas none of the patients died of legionellosis, two patients died six months later from their underlying disease. Most patients were treated with several antibiotics. In three patients definite improvement occurred only after therapy had been changed to doxycycline. Erythromycin, currently recommended as the drug of choice, was used in none of these cases.