[2014 update in general internal medicine]. / Médecine interne générale ambulatoire.

This article comments 9 original publications from year 2014 of interest for the primary care physician in the outpatient setting. The impact of diet such as nut consumption on health outcomes and mortality is developped, and the importance of dietary changes while taking statins is reminded. Red flags in low back pain and their predictive value are re-evaluated. An association between benzodiazepine use and Alzheimer dementia seems probable. New treatments for alcohol abuse, restless legs syndrome and type 2 diabetes are discussed. Finally, ß-bloquers' effects on respiratory function in asthmatic patients are beeing reexamined.

Long-term recording and automatic analysis of cough using filtered acoustic signals and movements on static charge sensitive bed.

Reliable long-term assessment of cough is necessary in many clinical and scientific settings. A new method for long-term recording and automatic analysis of cough is presented. The method is based on simultaneous recording of two independent signals: high-pass filtered cough sounds and cough-induced fast movements of the body. The acoustic signals are recorded with a dynamic microphone in the acoustic focus of a glass fiber paraboloid mirror. Body movements are recorded with a static charge-sensitive bed located under an ordinary plastic foam mattress. The patient can be studied lying or sitting with no transducers or electrodes attached. A microcomputer is used for sampling of signals, detection of cough, statistical analyses, and on-line printing of results. The method was validated in seven adult patients with a total of 809 spontaneous cough events, using clinical observation as a reference. The sensitivity of the method to detect cough was 99.0 percent, and the positive predictivity was 98.1 percent. The system ignored speaking and snoring. The method provides a convenient means of reliable long-term follow-up of cough in clinical work and research.

Nasal-CPAP, surgery, and conservative management for treatment of obstructive sleep apnea syndrome. A randomized study.

STUDY OBJECTIVE: To assess separately the effectiveness and safety of nasal-continuous positive airway pressure (N-CPAP) and that of surgery in comparison to conservative management in patients with obstructive sleep apnea syndrome (OSAS). DESIGN. A randomized study with 1-year follow-up. SETTING: A university hospital acting as a referral center for OSAS. PATIENTS: Symptomatic patients with OSAS (72 male and 4 female patients aged 18 to 65 years), who had oxygen desaturations in the overnight recording. INTERVENTIONS: After the initial diagnostic workup, patients were considered to be candidates for either N-CPAP (44 patients) or surgical treatment (uvulopalatopharyngoplasty [UPPP] with or without mandibular osteotomy) (32 patients). Within the groups, the patients were then randomized to either the assigned treatment or conservative management. MAIN OUTCOME MEASURES: The number of nocturnal oxygen desaturation events of 4% or more per hour in bed (ODI4); daytime somnolence; side effects. RESULTS: N-CPAP Group: Compliance with N-CPAP therapy at 1 year was 13 of 21. The most common reason for noncompliance was general intolerance of CPAP. All compliant patients had a normal ODI4 ( < 10), whereas 1 of 20 of their control subjects had a normal finding. Patients receiving active treatment were significantly less somnolent than their control subjects at 1 year (p < 0.05). SURGERY GROUP: At 1 year, 7 of 18 of the surgically treated and 1 of 14 of the conservatively treated patients had a normal ODI4 (p < 0.001). Daytime somnolence was significantly less severe in the surgically treated patients compared with their control subjects (p < 0.001) both at 3 and 12 months. The overall postoperative complication rate was 22%. CONCLUSIONS: N-CPAP is an effective therapy for OSAS, but compliance is a problem. Surgical therapy (UPPP with or without mandibular osteotomy) needs further evaluation.

Nasopharyngeal symptoms and nasal continuous positive airway pressure therapy in obstructive sleep apnoea syndrome.

Nasal problems are often reported during the treatment of obstructive sleep apnoea syndrome (OSAS) with nasal continuous positive airway pressure (nCPAP) and may jeopardize the use of nCPAP. This retrospective study evaluated the frequency of nasopharyngeal symptoms in OSAS patients before and during nCPAP treatment. A questionnaire was sent to all patients (n = 194) with OSAS for whom nCPAP had been prescribed during the years 1990-1995 at the authors' hospital, enquiring about nasopharyngeal symptoms both before and during treatment and nCPAP use. The study population consisted of the 151 patients [128 men and 23 women, median (range) age 54 (31-76) years and body-mass index 34 (17-54) kg/m2] who responded to the questionnaire. Seventy-one percent of patients were still using nCPAP after a median treatment duration of 30 months. The most commonly reported nasopharyngeal symptoms were nasal stuffiness, which was reported by 46% of patients before nCPAP and by 37% during nCPAP, dry nose (39% before and 46% during nCPAP), sneezing (36% and 35%) and rhinorrhoea (21% and 27%). The frequency of nasopharyngeal symptoms did not change with nCPAP treatment. The frequency of nasopharyngeal symptoms before and during nCPAP treatment was similar in those patients who discontinued the treatment (n = 44, 29%) compared with those who continued with nCPAP (n = 107, 71%). Skin problems caused by the mask (50%), airleak from mouth (44%), difficulty in exhaling (29%) and a sensation of suffocation (26%) were also problems associated with nCPAP treatment. Nasopharyngeal symptoms were common in patients with OSAS before nCPAP was started. There was no significant change in the frequency of these symptoms during nCPAP treatment. Nasopharyngeal symptoms did not seem to affect treatment continuation.

Living with arthritis--what is important?

PURPOSE: Demonstrating the effectiveness of health care interventions requires valid measurement of the impact of those interventions. However, outlining precisely what constitutes a 'good outcome' in the field of rehabilitation is no easy task and tends to rely on models proposed by 'experts' rather than people with the disabling conditions. This paper describes a study exploring outcomes that those people with a disabling condition (arthritis) consider important. METHOD: A qualitative study, interviewing 10 women with rheumatoid arthritis was carried out. The narratives were explored for categories and themes that encapsulated the perspective of the participants. RESULTS: A range of categories was identified and collated into five themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge). CONCLUSIONS: The research supports in part, but also challenges more commonly used models of understanding the important consequences of disease and disability. The findings of the study may assist health professionals to reflect on current practice and reconsider processes used, and outcomes aimed for, in light of what patients/clients consider important.

Eating disorders in a nonclinical adolescent population: implications for treatment.

The present study investigates the prevalence of adolescent eating disorders across gender, cultural groupings, and socioeconomic status. The Eating Attitudes Test, the Binge-Eating Questionnaire, and a demographic questionnaire were administered to students at two high schools. The results indicate a high rate of eating disorders in a nonclinical adolescent population. The rates for binge eating are comparable to those found in studies of college students--found at a younger age. With regard to SES, cross-cultural and gender findings, it is clear that eating disorders cross socioeconomic class and ethnic groups, and have a higher rate of occurrence in males than previously reported. Given such high rates of eating problems in a nonclinical population, the issue of prevention and early detection must be addressed. Additionally, more specific information on male eating disorders is needed.

[Capillaria hepatica in a dog and a hedgehog]. / Capillaria hepatica bei einem Hund und einem Igel.

A liver infection with Capillaria hepatica is described, having been found for the first time in Switzerland in a dog and a hedgehog. After a literature review of cases known among man and animals, we present our own pathological findings. Furthermore, the parasite's life cycle is discussed.

[Infectious hemorrhagic disease of rabbits in the Bern pathology institute (1988-90): seasonal and regional distribution and histopathological findings]. / Infektiöse hämorrhagische Krankheit der Kaninchen im Berner Sektionsgut (1988-1990): Zeitliche und regionale Verteilung sowie histopathologische Befunde.

Between 1988 and 1990 we have investigated 45 cases of the rabbit viral haemorrhagic disease (VHD) at our institute in order to ascertain: 1) both monthly and regional distribution of the disease: 2) the histopathological patterns of the disease. The VHD cases were particularly frequent between October and January and between May and August. They occurred in 7 cantons. The panlobular hepatocytic necrosis was observed in 80% of the cases, whereas in the remaining 20% the necrosis occurred in the periportal region. In 80% of the animals the spleen blood vessels were dilated with perivascular fibrin accumulation indicative of hyperpermeability. In two cases haemoglobin cages were observed in the kidney tubules.

Tumour necrosis factor-alpha (-308) gene polymorphism in obstructive sleep apnoea-hypopnoea syndrome.

Patients with obstructive sleep apnoea-hypopnoea syndrome (OSAHS) have elevated circulating levels of tumour necrosis factor (TNF)-alpha. The hypothesis in this study was that OSAHS might be associated with the TNF-alpha (-308A) gene polymorphism, which results in increased TNF-alpha production. This hypothesis was examined in OSAHS patients, their siblings and population controls. A total of 206 subjects were recruited. All underwent sleep studies and clinical review, and were subsequently classified as having OSAHS or not depending on apnoea-hypopnoea frequency, sex, age and symptoms. All subjects had blood collected and genotyping was performed on DNA extracted from peripheral leukocytes. Some 192 random UK blood donors were used as population controls. The results demonstrated a significant association for TNF-alpha (-308A) allele carriage with OSAHS (OR=1.8; 95% Confidence interval: 1.18-2.75) when compared with population controls. Siblings with OSAHS were significantly more likely to carry the TNF-alpha (-308A) allele. In addition, 21 pairs of male siblings discordant for carriage of the -308A allele showed a significant level of discordance for the OSAHS phenotype. In conclusion, this study demonstrates an association of tumour necrosis factor-alpha (-308A) carriage with obstructive sleep apnoea-hypopnoea syndrome, suggesting that inflammation may be implicated in the pathogenesis of this condition.

Comparison of three hypotensive anaesthetic methods for middle ear microsurgery.

Three hypotensive anaesthetic methods were compared in 123 patients undergoing middle ear microsurgery. Hypotension was induced with halothane (1 vol.%), nitroprusside (4.4 micrograms/kg/min) or the combination of halothane (0.5 vol.%) and nitroprusside (1.2 micrograms/kg/min). The compensatory rise in the heart rate was controlled with a beta-adrenergic receptor blocking agent, practolol, the mean need for which was 0.03 mg/kg in the halothane group and 0.1 mg/kg in the other groups. The mean duration of the hypotensive period ranged from 79 to 107 min in the groups. During the hypotension, the average mean arterial pressure ranged from 55 to 60 mmHg (7.33 to 8.00 kPa) and the mean heart rate from 67 to 79 beats/min in the groups. The PaO2 value in the nitroprusside and halothane + nitroprusside groups, but not in the halothane group, decreased statistically and in some cases clinically significantly. The only peroperative side effects were ECG changes (mostly junctional rhythm), the incidence of which ranged from 16 to 24% in the groups. The mean values for the degree of haemostasis rated by the otologist on a visual analogue scale between poor (0 mm) and excellent (100 mm) were 90, 73 and 89 mm in the halothane, nitroprusside and halothane + nitroprusside groups, respectively. Recovery in the halothane group was statistically highly significantly longer than in the other groups. No rebound hypertension occurred in any of the groups after discontinuation of the hypotension. The most common side effect was nausea + vomiting, the incidence of which ranged from 15 to 26% in the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Merkel cell carcinoma: the clinical course.

Merkel first discovered the cells named after him in the snout skin of voles in 1875. These cells are thought to originate from the neural crest and act as mechanoreceptors. When they have undergone malignant change, the neurosecretory granules in the cytoplasm may release various polypeptides, suggesting that the tumor is an APUDoma. In a computer search of the literature 121 cases were identified. It was revealed that the most common lesion is an erythematous nodule arising in the face or lower limb and occurring predominantly in women in their late 60s. The regional nodes became involved in half the patients, and the three-year survival was approximately 60%. Two unusual cases, in women 72 and 73 years old respectively, with metastasizing lesions that responded to a combination of surgery and radiotherapy are reported, and the literature is discussed.