[Systematic scientific quality improvement in surgical specialties. The AQS mode]. / Systematische wissenschaftliche Qualitätssicherung in den chirurgischen Fächern: Das Modell der AQC.

BACKGROUND: How can the new legal requirements (Law on Statistics 1992 with its corresponding regulations of 1993: minimum data record of the Federal Department of Statistics (BFS) with ICD codification and the law on medical insurance 1995 with its corresponding regulations of 1996: necessity of documenting quality and efficiency) be integrated into the daily hospital routine with reasonable expenditure of time and costs? METHOD: The BFS minimum data record was combined with additional information on quality improvement on one single questionnaire. The surgical departments of the Hospital Limmattal in Schlieren and the Regional Hospital Bienne founded the Association for Quality Improvement in Surgery (AQC) in 1995 and have tested the AQC system for two years. RESULTS: Until the end of 1997 data from 15,115 surgical procedures were collected in our database. In addition to the more time consuming collection of the "minimal data set of the Federal Department of Statistics (BFS)" which requires between 3 to 10 minutes, the collection of the additional AQC-data will take 1 to 3 minutes. DISCUSSION: There is an increasing expenditure of time and costs as a result of legal requirements. Expenditure may, however, be kept within manageable limits if a single questionnaire serves several purposes simultaneously. The AQC system does not only meet the legal requirements as to systematic quality improvement and BFS statistics, but can also be used for the annual statistics of the clinic, the statistics of individual surgeons, and for hospital comparisons provided other clinics adopt the system as well. There are no standards, reference areas or indicators as yet, but such tools may now be developed much more easily with comprehensive data available through the AQC system. CONCLUSIONS: The AQC system has proved to be a manageable tool in the hospital routine; it could thus be implemented as a wide-area system to provide systematic quality improvement and to meet other statistical requirements.

[Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis]. / Septische Pylephlebitis mit Nachweis von Gas in der Vena portae: seltene Komplikation der Sigmadivertikulitis.

Pylephlebitis, septic thrombosis of the portal vein and its branches, is an infrequent complication of intra-abdominal inflammatory processes which may lead to thrombosis of the portal vein or to liver abscesses. Air in the protal venous system usually predicts a fatal outcome. The survival rate calculated in all reported cases is less than 25%. It is important to detect portal venous gas early. In detection of portal venous gas, ultrasound and computed tomography are more sensitive than plain radiographs. Pylephlebitis used to be a dreaded complication of appendicitis, but the incidence of this disease has greatly declined since the development of antibiotics and modern surgical techniques. We present two cases of pylephlebitis associated with gas in the portal vein as a result of left colonic diverticulitis treated by bowel resection. In spite of the occurrence of portal venous gas, the outcome may be favourable if this disease undergoes prompt surgical treatment.

[Multiple sclerosis in northwestern Switzerland]. / Die Multiple Sklerose in der Nordwestschweiz.

From 1980 to 1987 an epidemiologic survey was conducted in northwestern Switzerland (population 523,000) with the aim of registering as many MS cases as possible. The prevalence for the entire region was 142 per 100,000, with a maximum of 164/100,000 in the city of Basle. Extrapolation suggests there are more than 8000 MS patients living in Switzerland. Other interesting results were: a sex-ratio of 2.2 females:1 male. The mean age at clinical onset was 31.6 years. The mean survival was 30.6 years. Prevalence has grown in recent decades, mainly due to longer survival and to changes in age structure. The incidence presumably remained unchanged.

[Acute appendicitis: avoiding unnecessary laparotomy in young women]. / Appendicitis acuta: Vermeidung der unnötigen Laparotomie bei der jungen Frau.

Eighty-eight consecutive patients undergoing surgery for clinical diagnosis of appendicitis are reviewed. The diagnosis was correct in 71 (85%), incorrect in 17 (15%). Of these 17 patients 5 suffered from other diseases demanding surgical treatment (diverticulitis, cholecystitis, torsion of ovarian cyst, pyosalpinx). Pain migration, local tenderness and WBC greater than 10,000/mm3 were significantly associated with appendicitis, whereas duration of pain, défense musculaire and body temperature did not allow any discrimination. In men, the diagnosis was correct in 42 out of 43, whereas in women only in 34 out of 45. All 11 women with incorrect diagnosis were less than 35 years old. We conclude that the diagnosis of appendicitis is particularly difficult in women younger than 35 years.