Swiss medical weekly
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In a retrospective study (1984-1992), new cases of human echinococcosis were registered in Switzerland based on information obtained from (a) questionnaires sent to 294 of the 300 acute hospitals in all parts of the country and to 17 institutes of pathology (268 answers form hospitals: 91%), and (b) from tracing back cases reported under the official notification system since 1 January 1988 by laboratories to the Federal Health Office or recorded at the Institute of Parasitology in Zurich. Cases were regarded as verified if the diagnosis was documented by unequivocal findings (by radiology, ultrasonography, pathomorphology etc. and often by additional detection of anti-Echinococcus antibodies). Patients with antibodies but without reports on further findings were classified as suspected cases. ⋯ Based on a total population (Swiss nationals and foreigners) of 6.62 million in 1988 and the case numbers of 1984-1992, the following average annual incidence rates per 100,000 inhabitants were calculated: 0.51 for all new cases, 0.38 for CE, 0.11 for AE and 0.01 for NSE. In the 37 years since 1956 there has been steady increase in new cases of CE due to the importation of such cases by foreigners, whereas the case numbers of AE have remained nearly constant with a range between 7 and 10 new cases per year. In our study 258 suspected seropositive patients were registered but not added to the total number of cases, due to the lack of further findings.
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The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. ⋯ Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.
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Swiss medical weekly · Sep 1995
Review Case Reports[Laparoscopic adrenalectomy in pheochromocytoma].
Standard adrenalectomy for pheochromocytoma was until recently performed via the transperitoneal open approach. The disadvantage of the open procedure is a more painful and longer recovery. ⋯ The advantage of the laparoscopic technique is excellent vision of the operative field with magnification even of very small vessels. The first two cases of laparoscopic right adrenalectomy at our institution are described.
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We describe 3 patients with a severe allergic immediate-type reaction to poppy-seeds, diagnosed from clinical findings, skin tests and specific IgE antibodies (CAP). All show a serologic positivity to sesame seed, possibly due to a cross reactivity to similar allergens. From 1978 until 1987 402 food allergy patients seen at the Allergy Unit, Department of Dermatology, University Hospital Zurich, Switzerland, included no case of allergy to poppy-seeds. Because of today's trend to vegetarian food such immediate type reactions can be expected to occur more frequently.
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In the treatment of bronchogenic carcinoma approaches vary depending upon whether the carcinoma in question is defined as a small cell or a non-small cell lung cancer. Small-cell lung cancer in the majority of cases must be seen as a systemic disease even with an early diagnosis. Because of this, chemotherapy is the dominant form of treatment. ⋯ Recent clinical trials indicate, however, that better results can be obtained when chemotherapy is applied in stage III. These encouraging results stem from a number of clinical studies, in which polychemotherapy containing cisplatin (with or without radiotherapy) was applied preoperatively to initially inoperable stage III non-small cell lung cancer patients. It must be noted, however, that up until now these positive results have been achieved mainly in uncontrolled clinical investigations which must be confirmed by larger controlled trials.