[Treatment of pneumonia acquired in the community]. / Traitement de la pneumonie acquise en situation communautaire.

The community-acquired pneumonia is a common and serious illness. Pneumonia is said to be community acquired if it is contracted outside of hospital environment or if it is diagnosed within the first 48 hours of hospitalisation. The pathogen remains unknown after investigations in around 50%. The patient should initially be treated empirically, based on the likely pathogens according to the patient's risk-factors, underlying diseases, severity of pneumonia and place of therapy. If recent guidelines are compared (American Thoracic Society, British Thoracic Society and the Infectious Disease Advisory Board) there are differences concerning epidemiology, patients classification and the empiric antibiotic treatment. The appearance of resistances and the recent availability of new antibiotics account partially for these differences. In order to avoid further resistances but still achieving an efficient treatment, coherent antibiotic schemes considering local microbiological epidemiology and patients classifications must be applied as proposed by different guidelines.

[Sleep apnea syndromes and traffic accidents]. / Syndrome d'apnée du sommeil et accidents de circulation.

The sleep apnea syndrome (SAS) is an independent and important risk factor of traffic accidents. The risk is further increased by cofactors such as alcohol intake or poor visibility driving conditions. It is still difficult to prospectively identify apneic patients at forseeable driving risk; previous accidents, reaction tests, steering simulation tests as different polysomnographic parametres appear to be the most promising markers. The initiation of nocturnal nasal continuous positive airway pressure treatment (nCPAP) normalizes patient's accident risk. Unfortunately there does not exist any accurate European nor national regulation dealing with issuing a driving licence for persons with sleep apnea disorder.

[Diagnosis of lung cancer]. / Depistage de la neoplasie bronchique.

Due to the frequent diagnosis at a late inoperable stage and the bad prognosis of metastatic disease, lung cancer has become the first cause of cancer mortality. Early detection is thus the only way to influence mortality as there is no good treatment available for advanced disease. In the eighties, large screening studies using standard chest X Ray and sputum cytology have not been able to show a significant reduction in global lung cancer mortality. However these studies are now largely criticized for their methodological flaws. Recently, a new technique using auto-fluorescence fibroscopy has been developed, which is able to detect dysplastic and in situ neoplastic lesions which are invisible to standard fibroscopic techniques. This technique holds great promise in the detection of early lesions. In addition, molecular biology techniques are being developed which aim at detecting early invasive lesions at a stage where surgical treatment is still curative. The addition of these two techniques will probably in the future increase the efficiency of lung cancer screening. Therefore we think that new large scale screening studies are needed.

[Bilateral sacroiliitis as an initial manifestation of sarcoidosis]. / Bilaterale Sakroileitis als Erstmanifestation einer Sarkoidose.

We report on the case of a 33-year old female patient with an acute case of a bilateral sacroileitis in sarcoidosis. Basing on this case report the various forms of joint sarcoidosis as well as differential diagnostic aspects are discussed.

[Primary amyloidosis of the lung]. / Primäre Amyloidose der Lunge.

We report on a female patient of 66 years of age in whom primary nodular amyloidosis of the lung was diagnosed on the basis of a chance radiological finding. Based on this case report we discuss the pathophysiology, diagnosis and clinical findings of pulmonary amyloidosis.

Metoclopramide does not affect renal function and atrial natriuretic peptide release in response to acute saline loading in conscious rats.

It was previously shown in man that metoclopramide (MCP), a dopamine (DA)-2 receptor blocker, attenuates the natriuresis of water immersion. In the present study, we therefore investigated the effects of MCP on renal function and atrial natriuretic peptide (ANP) release in conscious rats. Under basal conditions MCP did not affect glomerular filtration rate (GFR) (7.4 +/- 1.7 ml/min/kg without and 7.8 +/- 0.6 ml/min/kg with MCP), urinary fractional excretion of Na (FENa) (0.3 +/- 0.1% without and 0.3 +/- 0.1% with MCP) and K (FEK) (20.6 +/- 1.4% without and 28.0 +/- 6.2% with MCP) or plasma ANP (37 +/- 5 pmol/l without and 31 +/- 6 pmol/l with MCP). During acute saline loading equal to a 10% rise in body weight, which significantly (p < 0.05) increased GFR, MCP again had no effects on GFR (8.8 +/- 1.8 ml/min/kg with vs. 9.7 +/- 2.5 ml/min/kg without MCP), FENa (24.5 +/- 6.9% with vs. 20.4 +/- 5.1% without MCP), FEK (52.5 +/- 6.9% with vs. 52.5 +/- 9.5% without MCP) and plasma ANP (89 +/- 8 pmol/l with vs. 91 +/- 9 pmol/l without MCP). These results indicate that DA does not modulate renal function or ANP release via DA-2 receptors under basal conditions nor in response to acute saline loading in conscious rats.

[Cough, dyspnea, hemoptysis]. / Husten, Dyspnoe, Hämoptysen.

The 26-year-old man experienced symptoms of chronic airway obstruction with shortness of breath, cough and wheezing, which primarily led to a diagnosis of asthma bronchiale. Absence of adequate response to antiasthmatic treatment and development of hemoptysis and weight loss led to the tentative diagnosis of upper airway obstruction by tumor. Bronchoscopy revealed adenoid cystic carcinoma of the distal trachea.

[High-resolution computed tomography in the diagnosis of branchial otodysplasias. A report on 10 cases (15 ears)]. / La tomografia computerizzata ad alta risoluzione nella diagnostica delle otodisplasie branchiali. Rapporto su 10 casi (15 orecchi).

Computed Tomography (CT) is not yet widely employed in the evaluation of temporal bone diseases in pediatric patients. Our experience is reported in the study of branchial otodysplasias (10 cases, 15 ears) by means of a high-resolution program. Indications, advantages, limitations and risks of this technique are discussed. Some technical details are reported, such as number and type of scans, length of data acquisition, thickness and feed of slices, electronic image reconstruction, and radiation doses given to the lens. The method employed to immobilize younger patients is also described. CT findings in the single cases are summarized in the tables. The most significant images of 5 cases are also reproduced. A careful analysis of the cases in our series highlights the advantages provided by the use of high-resolution CT in the evaluation of the temporal bone in pediatric patients, especially as far as dysplasias are concerned.

[Fatigue, exertional dyspnea, unsteady gait]. / Müdigkeit, Belastungsdyspnoe, Gangunsicherheit.

Exertional dyspnea and fatigue dominated the clinical picture of pernicious anemia in a 78 year old man. A disturbed gait indicated concomitant neurologic disorders. A reduced Vitamin B12 level, an abnormal Schillingtest, atrophy of gastric mucosa as well as maturation disturbance of erythrocytes and neutrophils were present as typical signs of the disease. Administration of Cyanocobalamine led to correction of blood values within three weeks.