[In Process Citation].
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Journal Article↗
Biomedical subjects
F Caduff
Publications and source records attributed to F Caduff.
[Compulsory psychiatric drug therapy in Switzerland--legislation and reality exemplified by a few clinical cases].
We discuss the existing or desired legal basis for forced medical treatment in psychiatry, in the light of supranational, international and Swiss law. Four situations in which forced medical treatment may occur are described and illustrated with case reports. A distinction is drawn between treatment against a destructive will, treatment against lack of will, treatment against an antisocial will, and long-term treatment against a chronic destructive will. Finally, proposals for improved Swiss legislation on forced psychopharmacological treatment are discussed.
Adult↗
[Qulerulousness--a disappearing psychopathologic behavioral disorder?].
Compulsive Querulousness (CQ) is a term for behaviour characterised by an exaggerated feeling of righteousness and is not a specific ingredient of any particular psychiatric illness. CQ was well represented in psychiatric literature until the year 1960 both in textbooks and in single-case studies, but has disappeared from clinical psychiatric interest in the last 30 years. In the first part of our study we present the syndrome in its various facets (epidemiology, aetiology, categorisation, symptoms, therapy). In an epidemiological study we extracted in chronological order all patients with compulsively querulous behaviour hospitalised in our clinic during the years 1922-1951 and 1964-1993. We found the compulsively querulous behaviour has been more rarely diagnosed in the last 30 years. Possible reasons for this are the CQ was used in more negative terms in former times than today and, consequently, there is a tendency today to avoid the term CQ even in cases of clearly querulous behaviour. In the second part we present, in a cross-sectional study, biographical and personality characteristics of all "legal compulsively querulous persons" hospitalised during 60 years--a characteristic subsection of persons with compulsively querulous behaviour. We found, among other facts, a predominance of male gender, of medium or higher education and professional status, a trigger experience of injustice, and discuss their relevance in the formation of compulsive querulous development.
Adult↗
[Folie à deux. Review of the literature and an unusual case].
We present a review of the concept's history and discuss different possible varieties of "folie à deux". Following this we report the case of a couple whose "folie à deux" has lasted for ten years. They have four of their own children and three further children from the husband's first marriage. Of special interest is the personality of the protagonists, their psychological assessment, and the so far ineffective therapeutic interventions that have been undertaken in efforts to save the children.
Adolescent↗
[Evaluation of a strip test (Micral test) for the semi-quantitative assessment of microalbuminuria in clinical practice].
Microalbuminuria (AER 20-200 micrograms/min) is the earliest clinical sign of incipient diabetic nephropathy. Current methods for measuring urinary albumin are not suitable for use in an office setting. A test strip (Micral-Test, Boehringer Mannheim [D]) based on immunochemical principles has recently been developed which allows semiquantitative detection of urinary albumin concentrations. In this study Micral-Test results were compared with conventional immunoturbidimetric laboratory measurement. 65 single-void urine samples of diabetic patients were analyzed (38 type 1, 27 type 2). Urinary albumin values as obtained from Micral-Test and laboratory measurement showed a significant correlation (r = 0.85, p less than 0.001). An interclass correlation was performed for normal urinary albumin values (less than 20 micrograms/ml) and for microalbuminuric values (20-200 micrograms/ml) and resulted in correlation coefficients of 0.56 and 0.81 respectively. Interindividual variation was checked by three observers reading the same 13 urine samples. The values obtained from the three observers correlated significantly (r greater than 0.95, p less than 0.001). The test strip must be evaluated after precisely 5 minutes in order to avoid false pathological results. In conclusion, the Micral-Test is a good screening method for easy and quick detection of microalbuminuria in an office setting.
Adult↗
[A case from practice (214). Basedow disease with florid hyperthyroidism. Low-degree endocrine orbital disease. Atrial tachycardia due to the hyperthyroidism].
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Aged↗
[The practical assessment of micro-albuminuria as a marker for beginning diabetic nephropathy in: which urine sampling method?].
Microalbuminuria, i.e. elevated urinary albumin excretion rate between 20 and 200 micrograms/min, is a strong predictor of subsequent overt diabetic nephropathy. Screening for microalbuminuria is essential, since it has been shown that development of overt nephropathy can be delayed or even prevented by therapeutic measures such as strict metabolic control, early aggressive antihypertensive treatment, or restriction of protein intake. Several urine collection methods for the measurement of microalbuminuria have been proposed. In a prospective study with 40 diabetic outpatients we have compared albumin excretion in urine collected over 24 h, during a timed overnight period, and in a spot urine sample collected at random while the patient attended the outpatient clinic. In addition, the reproducibility of the three urine collection methods was assessed. For this purpose, each patient underwent 3 consecutive collections at an interval of at least 4 weeks. Our data indicate that calculation of an albumin/creatinine quotient in a spot urine probe is a reliable screening test for microalbuminuria. If this quotient is increased (greater than 2), timed overnight collection should be performed.
Adolescent↗
[The diagnosis of Cushing's syndrome. Results of diagnostic assessment of 20 patients with Cushing's syndrome of variable etiology (1979-1989)].
In the light of 20 cases of Cushing's syndrome the currently used diagnostic strategies are presented. For initial screening the classical dexamethasone suppression test using 1 mg dexamethasone p.o. and 24-hour urinary extraction of free cortisol were used, and diagnosis was confirmed using the 2 mg dexamethasone suppression test for two days. All three tests had a sensitivity of 100% in these 20 patients. Etiological evaluation was performed using basal ACTH plasma concentration measurement and the more recently available stimulation tests using corticotropin-releasing factor (CRF): in cases with suspected pituitary-hypothalamic etiology, selective catheterisation of the sinus petrous inferior with simultaneous blood sampling for measurement of plasma ACTH concentration was performed. Detailed etiological diagnosis is important in Cushing's syndrome since therapeutic measures differ widely: the etiologies in the 20 patients with Cushing's syndrome were: central Cushing's disease (microadenoma in 11, pituitary carcinoma in 1), adrenal carcinoma (3), adrenal adenoma (1), adrenal hyperplasia (1), ectopic ACTH production (2) and alcohol-induced Cushing's syndrome (1). The stepwise procedure in screening and diagnosis of the various etiologies of Cushing's syndrome are presented and the results of the 20 patients compared with the literature.
Adrenal Cortex Function Tests↗
[Diagnostic careers].
Careers of diagnoses: The case history of 80 schizophrenics, 40 borderline personalities and 20 persons with bipolar disorders, who were treated in the Basle University Psychiatric Outpatient Department for at least 5 years, were examined concerning the first diagnosis and the change of the diagnostic evaluation. On one hand the aim was to evaluate on which factors the first diagnosis was based (heredity, anamnesis, previous hospitalizations, actual psychostatus), on the other hand, how these changes of diagnosis could happen (course, new evaluation of psychopathology). It appeared that 60% of the evaluated schizophrenics and 40% of the evaluated patients with bipolar disorders had the same diagnosis at their first consultation as 5 years afterwards, but the same applied only to 12.5% of the patients with borderline personalities. These differences are significant. The average period between first contact and today's definitive diagnosis was 2.2 years for schizophrenics, 7 years for patients with bipolar disorders and 8.8 years for patients with borderline personalities. Also these differences are significant. Furthermore the first diagnosis but also the change of diagnosis and today's diagnosis were evaluated. Thereby it was examined if the original diagnosis and the diagnosis 5 years later can be understood or if they cannot be understood at all or have been made incompletely. The therapy of that time as well as the one of today have been examined and evaluated.
Adult↗
[Nocturnal hypoglycemia with reference to hormonal counterregulation in type I diabetics receiving insulin therapy].
Frequency, symptomatology and risk factors for nocturnal hypoglycemia were investigated in 77 type 1 diabetics. The patients were hospitalized overnight after a normal working day and were kept on their usual insulin regimen. Nocturnal blood sugar levels less than 2.8 mmol/l were found in 25% of 77 patients. In most cases the hypoglycemic event was not noticed by the patients. Additionally, nocturnal hormonal counterregulations were investigated in 22 patients. Plasma adrenalin, noradrenalin, somatotropin, cortisol and glucagon were measured every 2 hours. Although most of the patients were asymptomatic, a significant increase in plasma adrenalin was observed during hypoglycemia episodes. On the other hand, the increase in noradrenalin and somatotropin concentration was not significant. Blood sugar levels of 5 mmol/l and lower at 22 p.m. and at 7 a.m. (as well as diabetes duration) were identified as risk factors for nocturnal hypoglycemia. Nocturnal hypoglycemia occurs irrespective of the amount of insulin injected in the evening or at bedtime. Similarly, neither the time of late insulin injection nor the degree of metabolic control as assessed by HbA1c differed in patients undergoing hypoglycemic episodes and patients without hypoglycemia.
Adult↗
[Campylobacter jejuni: sepsis and meningitis in an adult without risk factors].
A case of Campylobacter jejuni meningitis with associated septicemia and positive stool culture in a normal host is presented. Clinical findings, course of the illness and serologic data are compared with data from the literature. The possibility of infection due to a serum-resistant strain of Campylobacter jejuni is raised. Retrospective analysis of immunity revealed normal humoral and cellular immunity in a healthy patient one year later.
Aged↗
[Hydrochlorothiazide-induced lung edema with shock].
We report the case of a 74-year-old woman who developed pulmonary edema and shock shortly after ingestion of one tablet of hydrochlorothiazide/amiloride. The clinical findings and course of the disease were characteristic of hydrochlorothiazide-induced pulmonary edema. 14 similar case are reported in the literature. Attention is drawn to this rare but dangerous side effect of a frequently used diuretic.
Aged↗
[173 cases of insulin-induced hypoglycemia admitted to the hospital].
From 1980 to 1985, 120 insulin-dependent diabetics were admitted to the emergency department of the Cantonal Hospital, Basle, for altogether 173 severe hypoglycemic attacks. Relating these numbers to a total of 700 insulin-dependent diabetics in Basle, this means an hypoglycemia incidence of 4.2 per 100 treatment years. The principal causes were: dietary error or increased physical activity (43.7%); increase in daily insulin dose by the patient or his doctor (14.6%); and other illnesses, mostly involving the gastrointestinal tract (10.9%). Age and duration of insulin treatment were risk factors for the occurrence of hypoglycemic episodes. Thus, comparing patients at the Cantonal Hospital with or without hypoglycemia, there were significantly more hypoglycemic attacks (p less than 0.05) in the group of patients aged over 60 years or who had been treated with insulin for more than ten years. Average daily dose of insulin was about the same in both groups (35.8 U daily with hypoglycemia; 39.6 U without). Regardless of the daily number of injections, hypoglycemia occurred most frequently between 10 and 13 h and before the evening meal between 17 and 19 h.
Adult↗
[Group poisoning by belladonna].
A case is reported of collective intoxication in nine youths through self-brewed belladonna tea. Apart from peripheral anticholinergic symptoms, some of them had delirious states with visual hallucinations. The self-made tea was re-brewed in the laboratory and from the measured concentration of atropine the ingested total dose of atropine was estimated at up to 3 mg or more per person. In delirious states of unclear origin in young people, especially drug abusers, the possibility of intentional intoxication with atropine-containing plants should be considered. Intravenous physostigmine is the antidote of choice.
Adolescent↗
[The relatively frequent incidence of severe sulfonylurea-induced hypoglycemia in the last 25 years in Switzerland. Results of 2 surveys in Switzerland in 1969 and 1984].
In 1969 and 1984 all emergency wards in Switzerland were asked to report on the incidence of severe episodes of hypoglycemia (HE) during treatment with sulfonylureas. Each of the two surveys referred to a ten-year period (period A 1960-1969, period B 1975-1984). The number of HE reported was 78 for period A and 116 for period B. The number of diabetics treated with sulfonylurea preparations was established on the basis of tablet consumption, which amounted to 35,000 in period A and 47,500 in period B. The incidence of hypoglycemia in each period was comparable (period A 0.22, and period B 0.24 per 1000 patient years), but differed with regard to the sulfonylurea preparations used. In period A hypoglycemic episodes occurred more frequently under chlorpropamide than under tolbutamide and carbutamide. In period B the incidence of episodes under chlorpropamide and glibenclamide was comparable, but was significantly higher than under tolbutamide and glibornuride. The risk of hypoglycemia occurring is thus significantly higher under glibenclamide and chlorpropamide than under glibornuride and tolbutamide. 6.5% of HE were fatal in period A, compared with 4.3% in period B. Advanced age proved to be a risk factor in HE: 77% of patients with HE were over 69 years of age, whereas only 50% of all diabetics treated with sulfonylurea preparations were in this age group. Further risk factors were impaired renal function (21%) and possible drug interactions (27%). There was less likelihood of recurrence of a hypoglycemic episode in period B than in period A.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗