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Biomedical subjects

B Yersin

Publications and source records attributed to B Yersin.

At least 73 records · Page 4Linked to original sources
PubMed1992

Drinking patterns among medical in-patients with reference to MAST categories: a comparative study.

The aim of the study was to describe the drinking patterns and alcohol consumption of patients screened by the Michigan Alcoholism Screening Test (MAST) in a sample of medical patients from a general hospital of a French-speaking, wine-drinking country. Data were recorded using a structured interview administered to 103 consecutively admitted 20-75-year-old MAST-positive patients and 103 age-matched and sex-matched MAST-negative controls admitted to the same ward. Relevant differences between MAST-positive and MAST-negative patients included the frequent report of recent and total abstinence in MAST-positive patients (23% versus 4% in controls), their tendency to drink alone, and less often during mealtimes, at home, or with family or friends than MAST-negative patients. Alcohol consumption was significantly higher in MAST-positive patients of both sexes with 250 and 270 g per week being the optimal discriminative cut-off level of consumption for men and women, respectively (kappa coefficient, 0.70 and 0.81, respectively). Regular drinking was the predominant drinking status of both MAST-positive and MAST-negative patients. This study suggests that a screening test such as the MAST, developed in an English-speaking country may be useful in a French-speaking, wine-drinking country. The test identified patients with drinking patterns that are culturally abnormal, yet in certain respects similar to those of alcoholic patients from other drinking cultures. These findings therefore emphasize the worldwide relevance of the concept of the alcohol dependence syndrome in addition to the transcultural usefulness of alcoholism screening tests.

Adult↗
PubMed1990

[Value and justification of screening for alcoholism].

The Swiss are heavy alcohol consumers. Since alcohol consumption is a risk-associated behavior, it is not surprising that alcohol-related medical and psychosocial morbidities are frequently observed. Related costs are therefore also substantial. To reduce alcohol-associated morbidities and related costs, it is essential that the physician's role include both health education counseling to patients (to reduce alcohol consumption) and systematic alcohol abuse and dependence screening. This study reviews current knowledge of alcoholism screening. It emphasizes the validity of some screening instruments such as standardized questionnaires, the accuracy of which appears to be superior to that of other commonly used tests such as biological markers of alcohol intake. However, there are numerous gaps in scientific knowledge of these screening instruments, due mainly to methodological problems in studies of this subject. The results of these studies are fragmentary since they are frequently generalized without caution from studies performed in non-medical patients. While these gaps are even more serious when the effectiveness and thus the justification of alcoholism screening is reviewed, recent studies have proposed more precise methods of screening and therapy, particularly for use in multidisciplinary medical settings. The leading role of physicians in building and studying the effectiveness of these models should be emphasized, since it is well-known that alcoholics are frequently medical patients. Another factor in favour of screening for alcohol problems is the favorable trend in medical costs for alcoholics under treatment. To allow development of alcoholism screening programs by physicians, it is indispensable that their medical education provide adequate information regarding this important health matter. Medical research on the issue of alcoholism screening should be also developed; cost-effectiveness analysis of such programs should be a priority, in oder to convince public health agencies, insurance companies and physicians themselves of the necessity of such efforts.

Alcoholism↗
PubMed1990

Characteristics of 167 consecutive traffic accident victims with special reference to alcohol intoxication: a prospective emergency room study.

This prospective study examined the characteristics of 167 consecutive traffic accident victims admitted to the emergency room of a major Swiss hospital with particular attention to the presence of a detectable blood alcohol concentration (BAC). The majority of the study population were male (71%), 16-29 years of age (56%) and occupants of an automobile or motorcycle (70%). Most patients were injured during the daytime, with nighttime accidents increasing towards the end of the week. Seventy-five percent of the injured were drivers of the crash vehicle and the majority (56%) were involved in multi-vehicle accidents. Fifty-three percent of all injuries consisted of internal lesions and/or fractures with motorcyclists and pedestrians being the most severely injured. There was a 21% incidence of alcohol intoxication (BAC greater than = 0.8 g/kg); 97% of intoxicated patients were male, of which 38% were 16-29 years of age. There was a distinct age-related alcohol intoxication pattern among males, with an intoxication rate of 20% in the 16-29 age range and 40% in the 30-75 age range. Alcohol-related accidents occurred predominantly in the nighttime and towards the end of the week, and victims of single-vehicle crashes were more likely to be intoxicated (28%) than those injured in multi-vehicle crashes (17%). Moped drivers exhibited the highest rate of intoxication (45%) followed by pedestrians (42%). Our study confirms the high prevalence of acute alcohol intoxication among traffic accident victims in Switzerland, a fact which needs to be considered by the treating medical care providers for the early detection and referral of alcohol-related problems, and which should be limited by effective preventive measures.

Accidents, Traffic↗
PubMed1990

Right arm involvement and pain extension can help to differentiate coronary diseases from chest pain of other origin: a prospective emergency ward study of 278 consecutive patients admitted for chest pain.

In a prospective study of 278 consecutive patients admitted to an emergency ward for chest pain, the 115 clinical and paraclinical parameters available at the time of admission were evaluated by computer comparison with the final diagnoses. The most valuable items for making the diagnosis were classified according to their sensitivity, specificity and predictive value. Among the 278 patients, 100 individuals had myocardial infarctions (MI), 47 had unstable angina, 25 had stable angina and 106 patients had a non-coronary disease. The twelve most sensitive items for distinguishing MI from other conditions were the following: sudden onset of pain (70%); duration of more than 60 min (88%); constriction and squeezing (79%); oppression (75%); prior anginal attacks (61%); sex male (72%); age over 60 years (74%); abnormal heart auscultation (62%); abnormal electrocardiogram (ECG) (98%); segment (ST) disturbances (86%); increased glucose level (77%); CKMB fraction greater than 6% of total creatine kinase (CK) level (63%). Among the twelve most specific items, also with the best positive predictive value, irradiation in the right arm is of most importance; among the 51 patients with right arm involvement, 48 suffered from a coronary disease and 41 from a myocardial infarction. The largest extension of pain was reported in the latter group. It is concluded that chest pain with a wide irradiation involving the right arm strongly suggests that a myocardial infarction is ongoing.

Arm↗
PubMed1990

[Alcoholism and the practicing physician].

Alcoholism is a major public health problem in Switzerland as in most Western industrialized countries. The general practitioner should be a key person in screening for alcohol abuse and dependency. Yet, the general practitioner should provide information and counselling upon the consequences of excessive alcohol consumption. In a strategy of routine screening by general practitioners, asking the patient about the quantity and the frequency of alcohol consumption, clinical examination and laboratory testing are less effective than a standardized questionnaire. Examples of questionnaires include the Michigan Alcoholism Screening Test (MAST) and the CAGE questionnaire. The rationale for systematic screening is that early pathological injuries due to excessive alcohol consumption are reversible. Yet, the prognosis seems to be more favourable where therapy begins early and the amount of psychosocial problems is limited. An early therapeutic intervention could be started as a multidisciplinary approach, targeting the patient and emphasizing the role of the patient's physician.

Alcohol Drinking↗
PubMed1989

[Medicosocial characteristics of hospitalized alcoholic patients in 2 internal medicine departments of hospitals in French-speaking Switzerland].

Two prospective studies were performed in the medical services of two hospitals located in the French-speaking part of Switzerland to assess the prevalence of alcoholism and the comparative medico-social characteristics of alcoholic and nonalcoholic patients aged 18 to 75. Both investigations used the Michigan Alcoholism Screening Test, with a cut-off score of 5. The prevalence of alcoholism was similar in the two institutions (19.6 and 20.5%) and was much higher in males (30 to 32%) than in females (3 to 5%). Among alcoholics, the percentage of unmarried or divorced patients was higher than in nonalcoholics, as was the percentage of unemployed and subjects from lower socio-economic brackets. The most frequent type of alcohol-related disease was alcoholic liver disease, encountered in 25% of alcoholics in both services. Cigarette smoking was also much more frequent in alcoholics (60%) than in nonalcoholic patients (29%). The length of stay was 2 days longer for alcoholics in both hospitals, despite the lower mean age of these patients.

Adolescent↗
PubMed1989

[Cure of recurrent ascites in alcoholic hepatitis following transient placement of a LeVeen shunt].

Three cases of severe alcoholic hepatitis associated with refractory ascites are reported. A LeVeen shunt was inserted which was effective and well tolerated. However, the shunt was removed in all 3 patients 8 months, 12 months and 9 years after insertion because of spontaneous migration (n = 2) or superior vena cava thrombosis (n = 1). At time of shunt removal all 3 patients had micronodular cirrhosis, but none had recurrent ascites during the 1-3 years of observation and despite the absence of diuretics. The eventual transient aspect of refractory ascites associated with alcoholic hepatitis is discussed, together with the potential beneficial and temporary role of LeVeen shunts in this condition.

Adult↗
PubMed1989

[Pulmonary complications and acid-base disorders in liver diseases].

Liver diseases are frequently associated with pulmonary complications and acid-base disorders, alterations which are frequently overlooked and thus undiagnosed in these patients. Among the respiratory abnormalities, mention should be made of the numerous functional and anatomic alterations responsible for arterial desaturation, the frequent chronic hyperventilation and the rare plexiform pulmonary hypertension. Acid-base disorders, especially respiratory alkalosis and metabolic alkalosis, are common. These conditions have a number of therapeutic implications since some of them play an important role in the pathophysiology of hepatic encephalopathy. The complications and their specific diagnostic features are reviewed and some therapeutic proposals are made.

Acid-Base Imbalance↗
PubMed1989

Accuracy of the Michigan Alcoholism Screening Test for screening of alcoholism in patients of a medical department.

To measure the applicability and validity of the Michigan Alcoholism Screening Test in a medical hospital department situated in the French-speaking part of Switzerland, the test was administered to 300 patients. The results of the test were validated in relation to the clinical diagnosis of alcohol abuse or alcoholism through a concordance analysis. The applicability rate was 89% and the agreement between test and clinical diagnosis was good, especially in young men. Positive and negative predictive values of the test were 0.69 and 0.92, respectively. These results suggest, therefore, that the Michigan Alcoholism Screening Test could be considered as a standardized, valuable, and transcultural screening and research instrument.

Adult↗
PubMed1988

[Diagnosis, clinical presentation and triage criteria of emergency patients admitted for chest pain: prospective study of 278 cases].

A prospective study of the clinical findings and transfer decision in 278 patients admitted to the emergency ward for chest pain showed that a combination of 115 clinical and ECG data makes it possible to predict 86% of acute myocardial infarctions and unstable angina (specificity 76%). However, the diagnosis of the emergency medical team was adequate in 91% of cases, yielding a 5% rate of unjustified admissions to the intensive care unit. Therefore, the utility of a decision algorithm based upon clinical and ECG data, as proposed by American authors, is questionable. Finally, the indication for transfer to the intensive care unit was not followed in a quarter of patients due to old age and/or associated diseases.

Acute Disease↗
PubMed1988

Experimental Escherichia coli endocarditis in rats: roles of serum bactericidal activity and duration of catheter placement.

Studies were undertaken to investigate the relationship of the sensitivity of Escherichia coli to the bactericidal properties of serum and the ability of different strains to induce and sustain endocardial infection in rats. Strains of E. coli demonstrated different degrees of serum sensitivity, as determined by a method which employed concentrations of serum from 10 to 95% and periods of incubation as long as 24 h. The greater the serum sensitivity of the E. coli strain, the less able it was to initiate infection and the more rapidly it was spontaneously eliminated from established infections. Endocardial infection with E. coli was established by intravenous challenge in rats with polyethylene catheters passing through the aortic valve into the left ventricle. An E. coli strain of low serum sensitivity was used; the initiation of infection depended upon the length of time the catheter had been in place and, in addition, whether the catheter was in place at the time of bacterial challenge. Removal of the catheter permitted spontaneous sterilization of the endocardial vegetations. The time necessary for sterilization was in direct proportion to the length of time the catheter remained in place following bacterial challenge. If the catheter was not removed, sterilization of the endocardial vegetations did not take place. These studies suggest that serum bactericidal activity is an important host defense mechanism, acting to prevent the initiation of endocarditis in the case of highly serum-sensitive E. coli and to sterilize experimentally induced endocarditis in the case of less-serum-sensitive bacteria. The catheter used to induce nonbacterial endocardial vegetations favored the colonization of vegetations by E. coli, and it delayed the spontaneous sterilization of infected vegetations which occurred in relation to the susceptibility of the strain to the bactericidal properties of the serum. This effect of the catheter was not attributable to bacteria remaining viable in its lumen, nor was it attributable to inhibition of the bactericidal capacity of the serum as measured in vitro. Whatever the mechanism responsible for the catheter effect, experimental studies of the evolution of infections established with this technique must take into consideration the duration of catheter placement and whether and for how long it was present before or after inoculation with test bacteria.

Animals↗
PubMed1987

Fatal cardiac arrhythmias and shock following yew leaves ingestion.

A 40-year-old woman presented with vomiting and abdominal pain following voluntary ingestion of 150 yew leaves. She developed ventricular conduction defects and arrhythmias unresponsive to medical treatment after admission. She expired five hours after yew ingestion from irreversible cardiogenic shock. More attention should be given to this rare but severe intoxication for which no effective therapy is known.

Adult↗
PubMed1986

[Fulminant gram-negative (CDC-dysgonic-fermenter 2) septicemia in a splenectomized patient].

In a 43-year-old woman admitted because of fever and high cardiac output shock, disseminated intravascular coagulation with purpura was present. The peripheral blood smear revealed the presence of intraleukocytic elongated bacilli, but growth of bacteria (further identified as DF2) in the blood cultures was detected only two weeks after admission. Despite intensive therapy with hemodynamic and respiratory support, associated with broad spectrum antibiotherapy, the patient died on the third day of hospitalisation. The past medical history of the patient revealed splenectomy for Hodgkin's disease 4 years previously, but no recent dog bite.

Adult↗