[Pulmonary auscultation in the era of evidence-based medicine]. / L'auscultation pulmonaire à l'ère de la médecine factuelle.

BACKGROUND: Distinction between normal and abnormal respiratory sounds is important for accurate diagnosis. CURRENT DATA: This paper describes the state of the art, scientific publications and ongoing research related to the respiratory sounds. The study includes a description of the various techniques that are being used to record auscultatory sounds and a physical description of known pathological sounds (wheezes and crackles) for which automatic detection tools have been developed. VIEWPOINTS: The next stage will include exploiting all the qualities of the sounds. This augmentation of the spectrum studied, linked to signal analysis techniques, will allow the definition of new characteristic markers.

Respiratory sound analysis in the era of evidence-based medicine and the world of medicine 2.0.

OBJECTIVE: This paper describes the state of the art, scientific publications, and ongoing research related to the methods of analysis of respiratory sounds. METHODS AND MATERIAL: Narrative review of the current medical and technological literature using Pubmed and personal experience. RESULTS: We outline the various techniques that are currently being used to collect auscultation sounds and provide a physical description of known pathological sounds for which automatic detection tools have been developed. Modern tools are based on artificial intelligence and techniques such as artificial neural networks, fuzzy systems, and genetic algorithms. CONCLUSION: The next step will consist of finding new markers to increase the efficiency of decision-aiding algorithms and tools.

Murine typhus identified as a major cause of febrile illness in a camp for displaced Khmers in Thailand.

Scrub and murine typhus have been identified as causes of illness among the 238,000 displaced Khmer people residing in temporary settlements on the Thai side of the Thai-Cambodian border. Still, the true extent of the problem and the relative frequency of infection with scrub typhus as compared to murine typhus are unknown. We evaluated consecutive patients with unexplained pyrexia (documented fever, no exclusionary diagnosis, and constitutional symptoms) in 1 temporary settlement over 1 month. Laboratory studies included culture of blood and assay of paired sera for rickettsial IgM and IgG antibody, for dengue IgM and IgG antibody, and for leptospiral IgM and IgG antibody. Among 37 patients (27 adults and 10 children), 28 (75%) had a rickettsiosis (26 cases of murine typhus and 2 cases of scrub typhus). No case of enteric fever, dengue, or leptospirosis was diagnosed. The illnesses of 9 patients were not identified. Signs and symptoms did not distinguish confirmed rickettsial infections from undiagnosed illnesses. The 1 month attack rate of rickettsial infection was 29/100,000 for children and 185/100,000 for adults. Murine typhus was a major cause of febrile illness in this settlement.

The ultrastructure of cultured Plasmodium gallinaceum ookinetes: a comparison of intact stages with forms damaged by extracts from blood fed, susceptible Aedes aegypti.

The ultrastructure of intact, mature and immature ookinetes of Plasmodium gallinaceum is compared with corresponding stages which have been damaged by Aedes aegypti extracts prepared during blood digestion. The study reveals some new details of ookinete ultrastructure. In particular the composition, development and mode of formation of the pellicle of plasmodial ookinetes is shown to be similar to that of other sporozoans. The pellicle is composed of three membranes, develops in the growing protrusion of the retort-shaped early ookinete and its inner layer is probably formed by fusion of peripheral vesicles. Staining with ruthenium red indicates the presence of a surface coat. Furthermore Golgi-like structures and lysosomes can be observed. After exposure to A. aegypti extracts the parasites exhibit signs of severe cell damage and degeneration, such as disintegration and vacuolization of the cytoplasm. Damage of the plasma membrane is demonstrated by its permeability for ruthenium red. Cell damage is particularly prominent in those cell parts which are not covered by the pellicle and therefore suggests a protective function for this structure.

Influences of blood digestion on the development of Plasmodium gallinaceum (Brumpt) in the midgut of Aedes aegypti (L.).

Blood digestion of Aedes aegypti and development of Plasmodium gallinaceum were shifted against each other by giving the mosquitoes two consecutive blood meals. In this way the parasites were exposed to an environment where blood digestion was more advanced than in single blood meals. This procedure had an inhibiting effect on oocyst production when the two blood meals overlapped; an enhancing effect when they were well separated. The results are explained by the action of trypsin-like proteases on the parasites and indicate that plasmodia 0-10 h after blood meal are more sensitive to the enzymes than later stages of the parasites.

In vitro damage of cultured ookinetes of Plasmodium gallinaceum by digestive proteinases from susceptible Aedes aegypti.

After exposure to extracts from blood fed A. aegupti cultured ookinetes of P. gallinaceum were damaged to various, defined extents. Immature ookinetes were found to be more sensitive to damage than mature ones. The damage was dependent on the digestion time after which the Aedes extracts had been prepared and could be correlated with the proteolytic activity in the extracts. Control experiments demonstrated that the factors responsible for damage were neither present in unfed mosquitoes nor in blood alone and that the damage was not a result of osmotic stress. After the treatment of the Aedes extracts with lima bean trypsin inhibitor the ookinete damage was much less, indicating that the Aedes trypsin was the major agent of damage. These results were supported by experiments in which the tryptic activity of the extracts was eliminated by thermal denaturation. It is concluded that in the mosquito midgut most of the ookinetes are damaged by digestive enzymes and that this is one factor leading to the discrepancy between the number of ingested macrogametocytes and the number of oocysts which is usually found in nature. It seems that the only ookinetes which have a chance of surviving are those which develop in the centre of the blood clot, away from the site of enzyme action.

The early preclinical diagnosis of osteoporosis measuring the pure trabecular bone density.

The major skeletal determinants of fracture risk are bone mass and postmenopausal bone loss with gradual destruction of trabecular bone architecture. Therefore, the management of osteoporosis is to prevent bone loss after menopause in women below 60 years of age. We need a screening test of bone mineral density (BMD) with the ability to identify correctly individuals with accelerated bone loss; unnecessary treatment has to be avoided. But without measurable extraskeletal factors, no technique assessing BMD as single test has the reasonable high sensitivity and specificity for the diagnosis of fast bone losers. It is on principle the repeated volumetric bone measurement--within 12 months--in the pure trabecular bone, especially at distal radius of the non-dominant arm with the peripheral quantitative computed tomography (pQCT), being able to detect accurately the individuals as fast bone losers with trabecular bone loss > 8 mg/cm3 or > 3.5% per year (prevalence about 35%). Only women with very high trabecular BMD (in highest quintile) have no risk for osteoporosis.

Continuous 20-24 hr Esophageal pH-monitoring in infancy.

With the aid of a specially designed combination electrode for infants, 20-24 hr monitoring of esophageal pH was undertaken in 15 infants, aged 5 wk-11 mo. Results demonstrated that the reflux time pH less than or equal to 4 was valid for this age group as for adults, to differentiate between physiologic and pathologic reflux. A new parameter, that of clearance time, defined as normalization time required to return to initial pH, was introduced to improve pH assessment. Both parameters showed a highly significant correlation in relation to each other, and were consistently in accord with the clinical symptoms.

Infertility in Central Africa: infection is the cause.

Determinants of infertility were studied in 340 women in Eastern Gabon, an area situated in the "infertility belt" of Central Africa. Fallopian tube occlusion was diagnosed in 82.8% of cases, showing the importance of infection-related causes. Women with tubal occlusion did not differ significantly from women with normal tubes in obstetrical history or prevalence of Neisseria gonorrhoeae or Chlamydia trachomatis on endocervical culture. Antecedents of pelvic inflammatory disease or a pelvic mass were significantly more common in the group with tubal occlusion. This group also had a significantly higher prevalence of serum chlamydial antibodies at a titer of 1/64 or higher. Hormonal factors were found in 31.7% of women, a cervical factor in 29.0% and mechanical factors in 5.6%. No diagnosis could be made in 12.2% of cases. During the investigation, 4.4% of women became pregnant. The predominance of infectious related causes of infertility makes it imperative to focus resources on prevention programs of upper genital tract infections in women.

PIP: Determinants of infertility were studied in 340 women in Eastern Gabon, an area situated in the "infertility belt" of Central Africa. Fallopian tube occlusion was diagnosed in 82.8% of cases, showing the importance of infection-related causes. Women with tubal occlusion did not differ significantly from women with normal tubes in obstetrical history or prevalence of Neisseria gonorrhea or Chlamydia trachomatis on endocervical culture. Antecedents of pelvic inflammatory disease or a pelvic mass were significantly more common in the group with tubal occlusion. This group also had a significantly higher prevalence of serum chlamydial antibodies at a titer of 1/64 or higher. Hormonal factors were found in 31.7% of women, a cervical factor in 29.0% and mechanical factors in 5.6%. No diagnosis could be made in 12.2% of cases. During the investigation, 4.4% of women became pregnant. The predominance of infectious related causes of infertility makes it imperative to focus resources on prevention programs of upper genital tract infections in women. The study sample is from a small semi-urban center of 25,000 inhabitants and consisted of all women consulting for infertility at the gynecology department of the Franceville hospital from January 1983 until December 1984.

[Evaluation of the dose-effect relationship of perindopril in the treatment of arterial hypertension]. / Evaluation de la relation dose-effet du perindopril dans le traitement de l'hypertension artérielle.

To evaluate the dose-effect relationship of antihypertensive drugs is essential to a rational determination of their effective dosage. Two double-blind and strictly controlled trials have demonstrated the effectiveness of perindopril 4 mg orally in the treatment of mild to moderate arterial hypertension (100 less than DAP less than 120 mmHg). The drug remained effective 24 hours after the last dose. The 2 mg dose proved insufficient to obtain a significant reduction of blood pressure. In case where the 4 mg dose was not sufficiently active, a better antihypertensive effect could be achieved with an 8 mg dose without major untoward reactions. The antihypertensive activity of perindopril was parallel to the percentage of angiotensin-converting enzyme inhibition induced by the compound. This study also illustrates clearly the value of semi-automatic blood pressure recording with the Dinamap system in the determination of dose-effect relationship, compared with the conventional sphygmomanometric method.

[The influence of the geographic, demographic and socio-economic factors on the mortality from ischaemic heart disease in Switzerland (author's transl)]. / L'influence des facteurs géographiques, démographiques et socio-économiques sur la mortalité par cardiopathies ischémiques en Suisse.

The age-standardized mortality rate of Swiss men from ischaemic heart disease (ICD 8th revision, codes 410-414) can be placed between the higher mortality rate of the Federal Republic of Germany and the lower one of France. A geographical gradient is also found within Switzerland: the German speaking areas register higher rates than the French speaking areas, and this difference is more pronounced for comparisons of large cities than for rural locations. These mortality rates are not biased by the other diseases of the heart (ICD codes 420-429). In addition to this geographical gradient, the socio-economic classes, marital status and the number of children are the best demographic and social indicators to discriminate in multivariate form the deaths from ischaemic heart disease among all deaths of men aged 45 to 64 years: the relative risk of dying from ischaemic heart disease is higher among men in non-manual professions (especially in non-independent situations) and among married men with two or none children. The results confirm the importance of the psycho-socio-cultural factors in the etiology of ischaemic heart disease.

[Cancer mortality according to occupation]. / Krebsmortalität nach Beruf.

The 55 profession groups, fully enclosing the male population of Switzerland, can be adjoined to a cancer risk category, according to their absolute and proportional mortality rate from 1979 to 1983 (age standardized for 35- to 74-years old). Lung-cancer mortality is for all building trade professions, even for building engineer and truck drivers, three times higher as for professions asking school-leaving examination. The carcinoma of the superior digestion tract and the bladder follow this falling incidence, while the opposite, profession specific falling incidence being shown by colon and rectum cancers and by the tumours of the lymphatic tissue and the prostata. Deduction of the results is cancer prevention: this should be carried out by a general, profession-orientated furtherance.

[Cancer mortality, according to social indicators]. / Krebssterblichkeit, mit Sozialindikatoren durchleuchtet.

The age-standardized annual mortality rates for 1969/72 are analyzed for each of 183 districts which have been characterized socio-economically and demographically on the basis of the 1970 census. Discriminant analysis for several malignant tumours shows increased mortality in regions of greater population density (lung cancer) and, independently of this finding, in regions with a higher proportion of persons working in the "tertiary sector" (other malignant tumours).

[Cervix smear: study prevalence in city dwellers in the climacteric]. / Zervix-Abstrich: Untersuchungsprävalenz bei Stadtzürcherinnen im Klimakterium.

Prevalence of pap smear test has been investigated among a sample of urban women 45 to 54 years of age without hysterectomy (n = 3096). Prevalence of pap smear test for the last three years was 19% among women without gynaecological operation and 10% among women with a gynaecological operation (excepted hysterectomy). A multivariate analysis has shown that: 1. The lack of pap smear test was relatively high among nulliparous women as well as in multiparous women (greater than = 3 children). 2. This prevalence was high, on the one hand among overweight women and women with particular lifestyle (high alcohol and caffeine consumption, low calcium intake), on the other hand among women having adopted a good lifestyle (no use of birth control pills or hormonal therapy, no alcohol or caffeine consumption, diet without meat).

[Occupation-specific indicators for strategic prevention in risk groups]. / Berufsspezifischer Indikator für die risikogruppenstrategische Prävention.

Using graphical representations to compare undistorted information it was attempted to bridge the gap between medicine and concerned risk-groups. Age-standardized mortality rates in 1979-1983 for 55 occupational groups (in 11 categories) of males aged 35 to 74 years were computed and compared to the Swiss national average; simultaneously the quantitative importance and the total mortality without accidents is shown for each occupational group: as an example the figure for lung cancer is reproduced. The elevated total mortality in the upper tertile of occupational groups is significantly explained by an increased risk of dying from circulatory or respiratory diseases, liver cirrhosis or malignancies of the lung, oropharynx, oesophagus or stomach. Foreseeable decrease of high-risk occupational groups will result in a further decline in mortality due to stomach cancer and cerebrovascular diseases in Switzerland.

[Regional variation in mortality from ischemic heart disease in Switzerland]. / Regionale Unterschiede der Mortalität an ischämischen Kardiopathien in der Schweiz

Age standardized mortality from coronary heart disease was found to be higher in the German speaking parts of Switzerland than in the French speaking parts. Mortality from other diseases of the heart does not show a contrary gradient. The same pattern was confirmed among a cohort of Swiss physicians, observed over a 18-year period. Differences in smoking habits cannot explain the differential mortality rates.

[Influencing factors related to narcotic consumption and leisure sports in juveniles]. / Einflussfaktoren auf Suchtmittelkonsum und Freizeitsport Jugendlicher.

This report presents some results of a survey of 2872 men and women of 17 to 18 years of age. A multivariate analysis shows a strong association of consumption of illegal drugs with that of tobacco and alcohol, as well as with absence of spare time sports activities (men) and excessive use of medicaments (women). The results favour a multifactorial model of prevention of drug abuse.

[Evaluation of the Swiss Hospital Association diagnostic and surgical statistics]. / Auswertung der VESKA-Diagnosen- und Operations-statistik.

Number of admissions, days of care and the average length of stay are presented by age, sex and other criteria for Swiss short stay hospital. Persons 60 and over consumed more than 50 percent of all days of care. On the average, females of all age groups, except from 5 to 54 years of age, were hospitalized longer than males. Principal factors influencing the length of stay are: age, diagnosis and mode of discharge. The increase in the number of persons 65 and over admitted to medical departments corresponds to the demographic development, while it exceeds the demographic increase for surgical departments.

Observations on the feeding habits of four species of Mansonia (Mansonioides) mosquitoes in Southern Thailand.

Studies on feeding habits of Mansonia annulata, M. annulifera, M. indiana and M. uniformis were carried out in southern Thailand. This study showed that M. annulata and M. uniformis were both strongly exophagic mosquitoes which avoided approaching and entering human dwellings. The biting frequency on the verandah was considerably higher than indoors. M. indiana was not repelled by houses but avoided biting indoors. M. annulifera was endophagic, it was attracted by houses and bit on the verandah as frequently as indoors. Some species showed differential preference for age- and sex-groups of human hosts: M. annulata was more attracted by adolescents and adults than by children and M. annulifera preferred female hosts. The other species did not distinguish between host groups.

[The placenta of premature and hypotrophic Gabonese infants]. / Le placenta de l'enfant gabonais, prématuré et hypotrophique.

494 placentae coming from two different geographical parts of Gabon were studied. They were grouped into control, premature, small-for-dates and stillborn. The urban population gives rise to most mothers of about 26 years of age, who deliver normally at 38 weeks of babies weighing 3,300 g and 50 cm long, with placentae weighing 550 g, as well as premature babies and those in which there is white cell infiltration of the membranes, signs of toxaemia and normal placentae. On the eastern plateaux of Gabon there are more mothers around the age of 23, who deliver normally at 37 weeks of pregnancy of babies weighing 3,100 g and 48 cm long, with placentae weighing 450 g, with small-for-dates babies and inflammation of the placenta. Malaria is the cause of many premature deliveries and of small-for-dates and stillborn, especially in the plateaux.