[A new treatment: bariatric surgery; a new complication: Wernicke-Korsakoff encephalopathy].

Introduction: Bariatric surgery has peripheral or central neurological complications in 5-10% of patients.

Case: We report the case of a 39-year-old man with metabolic syndrome who underwent gastric by-pass surgery and then lost 40 kg over a period of 2.5 months.

Adult hemolytic-uremic syndrome associated with urosepsis due to Shigatoxin-producing Escherichia coli O138:H-.

We report the case of a 62-year-old man without prodromal symptoms who developed a hemolytic-uremic syndrome (HUS) one week after the diagnosis of an acute bacteremic urinary infection (UTI). In this patient, the E. coli isolated in blood cultures was a non-O157:H7 Shigatoxin-producing strain that could subsequently be identified as O138:H-.

[Blood culture negative endocarditis: a diagnostic challenge].

Blood culture negative endocarditis (BCNE) account for about 5% of all cases of endocarditis. Diagnosis and initiation of antimicrobial therapy may be delayed, with a negative impact on clinical outcome. The most common cause of BCNE is antimicrobial drug therapy before blood sampling.

[Positive blood cultures during a 2 years period at Hôspital cantonal de Fribourg].

Several authors, mainly from the United States, have reported on the microbiology and interpretation of positive blood cultures. We conducted a retrospective study over a 2 years period to address this issue in a medium-size swiss hospital: two hundred and thirty-two episodes of positive blood culture were recorded, with 403 microorganisms; Escherichia coli (22%), Staphylococcus aureus (21%) and coagulase-negative staphylococci (110%) were the most frequent isolates. The latter were considered as contaminants in 38% of cases.

[Occupational exposures with risk of transmission of HIV, HBC and HCV in health care workers].

Health care workers are often victims of occupational injuries by contaminated sharps or projection of contaminated fluids to mucous membranes and are therefore at risk for transmission of HIV, HBV and HCV. Every technical and organisation-related measure useful to prevent injuries should be implemented and personal protection equipment must be made available to workers. Promotion of hepatitis B immunization is a key issue.

Reduced ejection fraction after myocardial infarction: is it sufficient to justify implantation of a defibrillator?

Background: Improved survival after prophylactic implantation of a defibrillator in patients with reduced left ventricular ejection fraction (EF) after myocardial infarction (MI) has been demonstrated in patients who experienced remote MIs in the 1990s. The absolute survival benefit conferred by this recommended strategy must be related to the current risk of arrhythmic death, which is evolving. This study evaluates the mortality rate in survivors of MI with impaired left ventricular function and its relation to pre-hospital discharge baseline characteristics.

[Prevention of secondary cases of invasive meningococcal infection: role of chemoprophylaxis and vaccination].

Prevention of secondary cases of invasive meningococcal disease is based on the rapid administration of chemoprophylaxis and depending on circumstances, conjugate vaccine against group C meningococci. The targeted group is close contacts of the patient, mainly household members. When two or more cases take place in schools, chemoprophylaxis and vaccination are offered to classmates and teachers.

Prospective epidemiologic survey of patients with community-acquired pneumonia requiring hospitalization in Switzerland.

Background: Community-acquired pneumonia (CAP) is a common problem and the principal infection requiring hospitalization, but its treatment is complicated by the difficulty in microbiological diagnosis and the increasing incidence of antibiotic resistance among respiratory pathogens. The purpose of this paper is to present the main epidemiologic features of patients with CAP requiring hospitalization in our country.

Methods: We enrolled three hundred and eighteen adult patients with CAP requiring hospitalization in seven large medical centers in Switzerland during two winter periods.

Life-threatening complications of hepatitis B virus-related polyarteritis nodosa developing despite interferon-alpha2b therapy: successful treatment with a combination of interferon, lamivudine, plasma exchanges and steroids.

Polyarteritis nodosa (PAN) is a rare vasculitis associated with hepatitis B virus (HBV) infection in a significant proportion of cases. When used to treat HBV-related PAN, immunosuppressive agents may enhance viral replication and relaspes are frequent. In recent years the use of antiviral drugs has been proposed.

Effect of sputum induction by hypertonic saline on specimen quality.

Microbiologic work-up of expectorated material is routinely used to search for the etiology of pulmonary infections, but sputum is often contaminated by saliva. Inhalation of hypertonic saline induces bronchial secretions and theoretically may improve specimen quality. We compared in a laboratory-blinded, randomized study the quality of sputum obtained either with induction by saline or without induction in patients with respiratory tract infection and a history of productive cough.

Repeated transient anuria following losartan administration in a patient with a solitary kidney.

We report the case of a 70-year-old hypertensive man with a solitary kidney and chronic renal insufficiency who developed two episodes of transient anuria after losartan administration. He was hospitalized for a myocardial infarction with pulmonary edema, treated with high-dose diuretics. Due to severe systolic dysfunction losartan was prescribed.

[Vaccination against influenza in the hospital milieu and by family physicians in Fribourg in 1997: facts and opinions].

The influenza vaccine was underused in Switzerland in 1996, as less than half of people at risk for the disease were vaccinated. We performed this study in 1997 to determine (1) the immunisation rate in the patients admitted to the internal medicine ward of the Cantonal Hospital, Fribourg and in those seen by family physicians, (2) the reasons underlying the decision of the physician to vaccinate their patients or not, (3) the physicians' opinion of the vaccination. The study was retrospective and included 383 patients hospitalised in the medicine ward between October 15 and November 25, 1997.

Outbreak of echovirus 30 meningitis in Switzerland.

This study includes 80 patients (38 children and 42 adults) who contracted aseptic meningitis in the summer of 1996 in Fribourg, Switzerland. Virological studies revealed an enteroviral infection in 65 out of 70 (93%) investigated patients. In 47 out of the 53 cases (89%) where a precise virus could be identified, the causative agent was an Echovirus 30.

[Multi-systemic toxicity of colchicine and renal failure: apropos of a case].

The use of colchicine can produce various side effects, but multiorgan toxicity is rare. We report the first Swiss case of multiorgan toxicity involving typical neuromuscular lesions. Muscular biopsy is a valuable tool in confirming the diagnosis.

Pasteurella multocida pneumonia with empyema.

We report a case of Pasteurella multocida pneumonia and empyema in an otherwise healthy patient. The most frequently observed human complication with this microorganism is a local wound infection. Only a few cases of pneumonia have been described, and most of the patients were immunodeficient.

Once-daily sparfloxacin versus high-dosage amoxicillin in the treatment of community-acquired, suspected pneumococcal pneumonia in adults. Sparfloxacin European Study Group.

The objective of this randomized, double-blind, multicenter study of 329 adult patients requiring hospitalization was to compare the safety and efficacy of sparfloxacin at a dosage of 200 mg once daily (following a 400-mg loading dose on day 1) with those of amoxicillin given as a 1-g oral dose three times daily for treatment of community-acquired pneumonia suspected to be due to Streptococcus pneumoniae. Success of treatment was determined by a combination of clinical assessment and chest radiography. Pneumococcal pneumonia was the confirmed diagnosis for 177 patients (54%).

[Epidemiology and care of myocardial infarct at the Fribourg Canton Hospital 1995].

Purpose: This study evaluates epidemiological data in a population of patients admitted for acute myocardial infarction in a large Swiss community hospital. It focuses on the application of recent drug treatment and newer therapeutic techniques.

Method: Data acquisition was based on medical records of all patients who were admitted to the Cantonal Hospital of Fribourg in 1995.

Sparfloxacin for the treatment of community-acquired pneumonia: a pooled data analysis of two studies.

A pooled data analysis of two double-blind studies encompassing 1137 episodes of community-acquired pneumonia in hospitalised adults, of which 560 were treated with sparfloxacin and 577 were randomised to comparator antibacterial agents (amoxycillin/clavulanic acid, erythromycin or amoxycillin administered at reference dosages), was performed. The global efficacy rate at the end of treatment in evaluable patients treated with sparfloxacin was 88.3% compared with 84.