[Vaccinations for overseas travelers--new evidence and recommendations]. / Impfungen für Auslandreisende--Neue Evidenz und Empfehlungen.

Vaccinations are an easy and highly effective way to keep travellers healthy. There are few problems with compliance, as all vaccinations are administered pretravel and many vaccines offer protection rates > 95% after a single dose (e.g. hepatitis A, yellow fever). Vaccination of hepatitis A and diphtheriatetanus are recommended for all developing countries. Polio is still indicated for Asia and Africa. Hepatitis B, if possible in combination with A, is recommended for persons travelling for > 30 days, travellers < 35 years, and for people showing special risk behaviour (e.g. high-risk sports, unprotected sexual intercourse). Depending on destination and kind and duration of travel, further vaccinations have to be considered, e.g.: yellow fever (endemic areas, rule of entry), rabies (trekking, travel in remote areas), typhoid fever (Indian sub-continent), meningococcal meningitis (meningitis belt, pilgrims to Saudi-Arabia), tick-borne encephalitis (endemic areas in Europe and Asia), influenza (persons at special risk of complications), Japanese encephalitis (low standard travel in rural areas of Southeast Asia > 30 days), measles (particularly endemic in Africa). Cholera vaccination is virtually never indicated. Several vaccines can be delivered at the same time.

[How important are attitudes towards washroom hygiene and spitting in schools? A telephone survey of school attendants in the Baselstadt canton, April 1998]. / Spuck- und Toilettenhygiene an Basler Schulen: wie wichtig? Eine Umfrage bei Schulhauswarten im Kanton Baselstadt, April 1998.

The aim of the study was to evaluate the risk spitting poses for students at Basle schools and to document the state of their toilet facilities. A telephone survey with 43 caretakers of the 56 Basle schools revealed, that spitting was considered a problem at 75% of the schools and that at every 4th school it had recently gotten worse. Apart from spitting on the floor (93%), spitting at walls and windows (32%), doors (20%), mirrors (16%), and occasionally at other persons (14%) occurred. Just about every school was equipped with the advised number of toilet units and urinals. On the other hand, 29% of handdrying mechanisms and 36% of soap-type offered as well as 39% of cleaning frequencies of facilities did not correspond to advised norms. 93% of toilet flushing mechanisms, 38% of the urinals and 96% of the washbasins had to be operated manually. This survey shows that spitting was common at practically every Basle school. Spitting at each other which is risky for infection occurred only sporadically. The risk of infection by spitting probably plays a minor role compared to other routes of infection. Despite this we advise a renewed effort in informing parents and students. Toilet hygiene at Basle's schools is still deficient. The facilities should be improved by midterm investments.

[Acute ischemia after intraarterial drug injection]. / Akute Ischämie nach intraarterieller Drogeninjektion.

HISTORY AND CLINICAL FINDINGS: A 36-year-old patient presented with a severe hand ischemia after intraarterial injection of four dissolved tablets of Methylphenidate each 10 mg (Ritalin into the right radial artery. INVESTIGATIONS: Non-invasive vascular diagnostic demonstrated a normal perfusion of the radial and ulnar artery and a severe ischemia of the small vessels of the right hand. TREATMENT AND COURSE: Under suspicion of a combined vaso-spastic and thromboembolic arterial occlusion we started an intraarterial lysis therapy followed by anticoagulation with heparin and infusions of prostaglandines. Despite this therapy necroses of three fingers developed; partial amputation was followed by a good wound healing. CONCLUSIONS: Ischemia of an extremity after intraarterial injection of drugs is a vascular emergency.

[Diagnosis and antibiotic therapy of infections in outpatients]. / Abklärung und Antibiotikatherapie von Infektionen in der Hausarztpraxis.

BACKGROUND: The study aim was to analyse the diagnostic and therapeutic approach to selected infectious diseases, in particular with regard to the use of antibiotics, in the light of current guidelines and the problem of developing resistance. METHODS: A questionnaire was sent to all physicians with a general or internal medicine practice in the Cantons Basel-Stadt and Basel-Landschaft, Switzerland. RESULTS: Of 440 physicians, 286 (65%) took part in the study. The most frequent diagnoses of infection were cystitis (16.6%), flu-like syndrome (16.4%), acute bronchitis (12.3%), and tonsillopharyngitis (10.1%). The most frequent indications for antimicrobial therapy were cystitis (19.9%), acute sinusitis (14.1%), acute bronchitis (11.5%), and tonsillopharyngitis (9.2%). Macrolides (24.0%), aminopenicillins (22.6%), and fluoroquinolones (16.8%) were the most frequently prescribed antibiotics. CONCLUSIONS: The majority of physicians diagnosed and treated according to rational principles. However, a few exceptions were found, e.g. omission of x-ray in the diagnosis of pneumonia (24%), the use of antibiotics in the treatment of viral diseases and antibiotic therapy for tonsillopharyngitis despite a negative rapid antigen detection test against group A streptococci (75%).