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H Stalder

Publications and source records attributed to H Stalder.

At least 73 records · Page 4Linked to original sources
PubMed1986

[Self-monitoring of physicians for the detection of iatrogenic diseases].

Iatrogenic diseases are defined as illnesses due to diagnostic or therapeutic procedures. The authors explore the possibility of recording iatrogenic diseases by a physician self-monitoring system. The responsible physician himself records his/her patients' iatrogenic complications on hospital discharge, after which the authors examine retrospectively all charts of the patients involved and a random sample of patients not included. The results show that in one year 208 of 1618 patients were recorded as having an iatrogenic disease which was severe in 88. 7.1% of these cases were not confirmed retrospectively (false positives). On the other hand, about one third of iatrogenic illnesses were not recorded (false negatives), though these were less severe cases only. We calculated that 17% of our patients had iatrogenic diseases, 22% of these were predictable. About a third of the patients had iatrogenic disease before hospital admission, and these patients had more severe, and other, iatrogenic diseases than those who acquired them during hospitalization. Iatrogenic complications affect other organ systems than non-iatrogenic acquired diseases. On average, patients with iatrogenic diseases were 6 years older and hospitalized 10 days longer than other patients. Although not all cases may be recorded, we believe that physician self-monitoring is preferable to other systems for recording iatrogenic diseases, since it may have a direct teaching effect on those who cause the illness.

Humans↗
PubMed1986

Use of ciprofloxacin in the treatment of Pseudomonas aeruginosa infections.

The therapeutic efficacy and safety of ciprofloxacin was studied in 30 patients with Pseudomonas aeruginosa infections. In 20 patients ciprofloxacin was given alone and in 10 patients (including 8 compromised hosts) in combination with an aminoglycoside (9) or azlocillin (1). Ciprofloxacin was given in doses of 500 mg orally or 200-300 mg i.v. every 12 h. In patients receiving only ciprofloxacin clinical cure with eradication of bacteria was obtained in 15 patients (75%) with infections of bone and joint (6), skin and soft tissue (4), lung (2), middle ear (2) and CSF (1). Two patients with lymphoma and Pseudomonas aeruginosa pneumonia died. In patients receiving combination therapy a definite therapeutic success was achieved in four (40%). Three patients with Pseudomonas aeruginosa septicemia died. In seven patients nine bacterial strains with decreasing susceptibility of ciprofloxacin (increase in MIC from less than or equal to 0.5 micrograms/ml to 2-16 micrograms/ml) were selected (6 Pseudomonas aeruginosa, 1 Enterobacter cloacae, 1 Serratia marcescens, 1 Staphylococcus aureus). Ciprofloxacin was well tolerated. This new quinolone seems to be suitable for single drug treatment of Pseudomonas aeruginosa infections in patients with normal host defense mechanisms, while its therapeutic potential in compromised hosts requires further evaluation.

Administration, Oral↗
PubMed1986

Symmetrical peripheral gangrene in disseminated tuberculosis.

We report the case of a 66-year-old man who developed a symmetrical peripheral gangrene (SPG) on both feet during disseminated miliary tuberculosis. Mycobacterium tuberculosis was not only isolated from sputum, gastric juice, and urine, but also from a blood culture. Since a disseminated intravascular coagulopathy was very likely to be excluded, it is possible that the SPG was due to embolization of arterioles by the tubercle bacilli. The literature of SPG is reviewed and the different possible pathogenic mechanisms of SPG, such as hypoxemia, vasoconstriction, primary endothelial damage, and vascular obstruction, are discussed. SPG is another cutaneous manifestation of disseminated tuberculosis.

Embolism↗
PubMed1986

Persistent pulmonary granulomas after recovery from varicella pneumonia.

A 41-year-old man was found to have a miliary infiltrate on chest roentgenogram two months after recovery from varicella pneumonia. The patient remained in good health and there was no objective sign of pulmonary disease. The infiltrate showed no change in subsequent serial chest films, and after one year, open lung biopsy was performed. Histology revealed isolated necrotizing granulomas with a mononuclear infiltration and a fibrous capsule. We discuss the differential diagnosis of pulmonary granulomas and conclude that the roentgenographic and biopsy findings probably represent a persistent lesion after varicella pneumonia.

Adult↗
PubMed1985

[Frequency of toxic-shock-syndrome-toxin producing strains of Staphylococcus aureus in the Basel region].

An attempt was made to explain the fact that toxic shock syndrome (TSS) is far less often observed among Swiss women than in the USA. To this end, 353 patients were examined for vaginal infection with Staphylococcus aureus, and 131 strains of Staphylococcus aureus of various origins tested for the formation of "toxic shock syndrome toxin one" (TSST-1). In addition, the patients were questioned about the use of tampons for menstrual hygiene. Taking all age groups into consideration, 2.3% of the 353 patients, and 4.8% of those younger than 27 years, were Staphylococcus aureus carriers. 19.8% of the tested strains of Staphylococcus aureus produced TSST-1. Since these figures are comparable with the US statistics, they afford no explanation for the difference in the incidence of TSS. On the other hand, it seems very probable that the much less common use of tampons, especially the highly absorbent variety, could be responsible. It is also possible that TSS is less often recognized and reported in Switzerland.

Adult↗
PubMed1985

Etiology of acute infectious diarrhea in a highly industrialized area of Switzerland.

During an 18-mo period between 1981 and 1982, a prospective study was conducted in 119 adult patients with acute diarrhea. A diarrhea-inducing microorganism or toxin could be identified in 38.7% of the patients. Salmonella sp and Campylobacter jejuni were the leading agents that caused diarrheal illness in 25% of the investigated population. Clostridium difficile was found in 6%, mainly after previous antibiotic therapy. Rotavirus was rarely isolated and enterotoxigenic Escherichia coli were not found. Clinical features in patients in whom an invasive agent was isolated did not differ from those in patients in whom no enteropathogens were found, although the occurrence of fecal leukocytes and positive hemoccult tests in the former group was significantly more frequent. More than 30% of the patients with negative stool cultures, however, showed fecal leukocytes and positive occult blood, which is suggestive of the existence of one or more invasive agent(s) so far unknown or not recognized.

Acute Disease↗
PubMed1983

[Contribution to the epidemiology of Campylobacter jejuni. From asymptomatic excretion by a cow in the cowshed to overt disease in over 500 persons].

An outbreak of C. jejuni enteritis involving participants of a jogging rally is described. Information was obtained by questionnaire about food consumption, incubation period, duration of illness and symptomatology. A drink prepared with raw milk was incriminated as vehicle of the outbreak. More than 500 runners were symptomatic with an attack rate of over 75%. Secondary cases were rare. Using serotyping, milk from a single cow fecally excreting C. jejuni type 2 was suspected to be the outbreak vehicle.

Animals↗
PubMed1983

Ceftazidime in severe infections: a Swiss multicentre study.

A total of 105 patients (mean age 57, range 15 to 90) with serious infections were treated with intravenous ceftazidime, usually 2 g 8-hourly. Most patients had complicating factors such as major surgery, cancer, chronic obstructive lung disease, catheters or anatomical abnormalities. Eighty-seven infectious episodes in 77 patients could be assessed for efficacy. Bacteraemia was diagnosed in 26% of these episodes. Seventy-five per cent of infections were due to Gram-negative bacteria, Pseudomonas aeruginosa being the most frequent. The major sites of infections were the lower respiratory tract (30), the urinary tract (28), the soft tissues (9), the biliary tract (4), bones (4) and the ears (4). Overall, 67% of the patients were cured, 20% improved, 7% relapsed and 6% failed to respond. Among the 27 infections due to Ps aeruginosa, only two failures (in the same patient) and four relapses were recorded. However, in the two failures and in three other cases with persistent Ps. aeruginosa colonisation, the organism had become resistant to ceftazidime. Three failures were recorded in the seven Staphylococcus aureus infections included in this study. Superinfection occurred in four patients. Adverse events included rash (6), Clostridium difficile toxin-induced diarrhoea (3), transaminase elevation (3), weakly positive Coombs test (10). Ceftazidime appears to be safe and effective for the treatment of severe Gram-negative infections, including those caused by Ps. aeruginosa.

Adolescent↗
PubMed1982

[Viral diarrhea].

Viruses are one of the most frequent causes of acute infectious gastroenteritis. Thus, rotaviruses are responsible for 40-60%--and in winter sometimes for over 90% - of diarrhoea in infants. These viruses may also cause disease in adults, but small viruses of a size of about 27 nm, such as the Norwalk agent, play a much more important role. Several other non-cultivable viruses such as adeno-, calici- and astroviruses have been implicated as a cause of infectious diarrhoea. Knowledge of rotaviruses is so far advanced that routine laboratory diagnosis can easily be performed and active immunization against rotavirus infection envisaged.

Adult↗
PubMed1981

[Toxic shock syndrome].

Two young female patients are presented who answered to the criteria for diagnosis of toxic shock syndrome, which was first described in 1978 and reached an epidemic peak in 1979 and 1980 in the USA. The disease almost exclusively affects women using tampons during menstruation and is characterized by fever, hypotony, multisystem involvement and exanthema following by skin desquamation. The disease is closely associated with the isolation of S. aureus in the vagina or elsewhere and is probably caused by a staphylococcal toxin.

Adult↗
PubMed1980

Microneutalization of cytomegalovirus.

A simple microneutralization test for cytomegalovirus (CMV) is presented. Using a laboratory adapted stock virus, definite results were obtained after 10 days. All patients with primary CMV infection showed an antibody rise and/or seroconversion; however, neutralizing antibody appeared only seven weeks after the onset of clinical symptoms. In control patients without evidence of recent primary infection, there was a complete concordance of the presence of complement-fixing and neutralizing antibodies.

Animals↗
PubMed1980

Time course of lung function changes in atypical pneumonia.

We measured pulmonary function in each of 21 patients suffering from "atypical", non-bacterial pneumonia during the acute illness and during convalescence (two to 18 months) to study the course and the nature of functional impairment at different stages of the disease. In six patients, no aetiological agent was found. An aetiological agent was identified in 15 of the patients: Mycoplasma pneumoniae (seven patients), influenza A (three patients), parainfluenza 3 (one patient), varicella (two patients), Q fever (one patient), coxsackie B3 (one patient). At the time of admission we observed a restrictive pattern in 52%, an obstructive pattern (decreased FEV1/FVC ratio) in 52% abnormalities in distribution of ventilation (abnormal slope of phase 3) in 63%, and abnormalities in gas exchange (increased AaDO2) in 75% of the patients. The frequency of abnormalities in these pulmonary function tests decreased dramatically after two to four weeks and nearly disappeared in most patients during convalescence. The only major residual abnormality was a decreased FEV1/FVC ratio in five subjects, four of whom were smokers. However, when MMEF and V75 were measured at this stage, their average value for all the groups of patients with the exclusion of the Mycoplasma pneumoniae group, was markedly reduced. These data suggest that small airways involvement can be demonstrated during the convalescence of patients recovering from various types of atypical pneumonia other than those caused by Mycoplasma pneumoniae.

Adult↗