Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series.

OBJECTIVES: The aim of this study was to describe the demographic, social and medical characteristics, and healthcare use of highly frequent users of a university hospital emergency department (ED) in Switzerland. METHODS: A retrospective consecutive case series was performed. We included all highly frequent users, defined as patients attending the ED 12 times or more within a calendar year (1 January 2009 to 31 December 2009). We collected their characteristics and calculated a score of accumulation of risk factors of vulnerability. RESULTS: Highly frequent users comprised 0.1% of ED patients, and they accounted for 0.8% of all ED attendances (23 patients, 425 attendances). Of all highly frequent users, 87% had a primary care practitioner, 82.6% were unemployed, 73.9% were socially isolated, and 60.9% had a mental health or substance use primary diagnosis. One-third had attempted suicide during study period, all of them being women. They were often admitted (24.0% of attendances), and only 8.7% were uninsured. On average, they cumulated 3.3 different risk factors of vulnerability (SD 1.4). CONCLUSION: Highly frequent users of a Swiss academic ED are a highly vulnerable population. They are in poor health and accumulate several risk factors of being even in poorer health. The small number of patients and their high level of insurance coverage make it particularly feasible to design a specific intervention to approach their needs, in close collaboration with their primary care practitioner. Elaboration of the intervention should focus on social reinsertion and risk-reduction strategies with regard to substance use, hospital admissions and suicide.

Antiretroviral treatment and osteonecrosis in patients of the Swiss HIV Cohort Study: a nested case-control study.

We examined risk factors for avascular bone necrosis (AVN) particularly focusing o the question of whether antiretroviral treatment (ART) is associated with the emergence of osteonecrosis. After 11 years of following the entire cohort, 26 patients were found to have AVN. Compared to 260 concurrent HIV-infected controls, at risk when cases were diagnosed, patients with AVN had lower CD4 cell count nadirs (median 86.5 versus 137.5 cells/microl, p = 0.010) and suffered significantly more often from Pneumocystis pneumonia, cerebral toxoplasmosis, CMV retinitis, and atypical mycobacteriosis and had a significantly higher body mass index than controls. Duration of ART before AVN was not significantly different between cases and controls (2.92 versus 2.17 years, p = 0.30). In conclusion, AVN could not be attributed to time on antiretroviral treatment, but patients with AVN had histories of more severe immunosuppression and a higher body mass index than controls.

Lumbar paraspinal rhabdomyolysis and compartment syndrome after abdominal aortic aneurysm repair.

Lumbar paraspinal compartment syndrome is an extremely uncommon condition that is known to occur after strainful exercise or trauma. We report on the original case of a 55-year-old man in whom lumbar paraspinal rhabdomyolysis and compartment syndrome developed after open abdominal aortic aneurysm repair, documented with technetium Tc(99m) bone scan and computed tomographic imaging, and in whom successful complete recovery was achieved with conservative management. Clinical features, pathophysiology, and diagnostic and therapeutic strategies of this unusual adverse event are discussed.

Evaluation of abdominal aortic aneurysm after endoluminal treatment: comparison of color Doppler sonography with biphasic helical CT.

OBJECTIVE: The purpose of this study is to compare color Doppler sonography with biphasic helical CT in the evaluation of abdominal aortic aneurysms after endovascular repair. MATERIALS AND METHODS: Fifty-five patients prospectively underwent both color Doppler sonography and helical CT within 7 days after treatment by endovascular stent-graft. Aneurysmal thrombosis, the patency of the grafts, and the presence of a leak were evaluated in all patients. When a perigraft leak was observed, an attempt was made to identify its origin and outflow vessels. Helical CT was considered the gold standard technique. RESULTS: Helical CT revealed aneurysmal thrombosis in 33 patients and a perigraft leak in 22 patients. In five patients, helical CT detected a small perigraft leak not shown by color Doppler sonography. In three patients with suboptimal examinations, color Doppler sonography revealed a suspected perigraft leak that was not confirmed by helical CT. In these eight patients, the perigraft leak was sealed or no longer observed during follow-up. Compared with enhanced helical CT, the sensitivity and specificity of color Doppler sonography for the diagnosis of a perigraft leak were 77% and 90%, respectively. In seven other patients, helical CT was superior to color Doppler sonography in detecting the origin of the perigraft leak and the outflow vessels. Two iliac artery dissections and one distal migration of the prosthesis were revealed only by helical CT. CONCLUSION: Although color Doppler sonography may detect substantial perigraft leaks, helical CT is superior for detecting the origin of the perigraft leak, the outflow vessels, and the detection of complications related to the procedure.