Psychoactive drug use among medical doctors is higher than in the general population.

We surveyed a representative sample of practising physicians and a representative sample of subjects from the Swiss general population (SOMIPOPS Survey) concerning their annual use of sleeping pills and tranquillizers. 77% of the physicians (n = 466) and 72% of the general population (n = 4255) responded. After adjustment for age and sex 37.1% of the doctors (general population 21.1% P less than 0.001) claimed to have taken these drugs for therapeutic purposes. The proportion of psychiatrists who reported taking sleeping pills and tranquillizers daily (10.6%) were significantly greater than for the population of doctors as a whole and for the general population (P less than 0.05). Regular users (i.e. subjects taking one mood altering drug at least once a week) accounted for 11.1% of the medical population compared with 6.8% of the general population (P less than 0.01). This over-consumption was wholly due to the greater number of regular users of psychoactive drugs amongst doctors less than 50 years of age relative to the general population or to subjects in higher management (from P less than 0.05 to P less than 0.001). Without this specific over-use, members of the medical profession would not have been found to use more psychoactive drugs than the general population and the executives. This result suggests that it would be worth investigating the mechanisms of response and adjustment (coping) to the specific stress that appears to be inherent in the exercise of medical practice.

[Eosinophilia and dormant parasitosis]. / Eosinophilies et parasitoses dormantes.

The exotic diseases are still far from a daily preoccupation and sometimes face the physician with unusual problems. Two classical situations are reported: eosinophilia of parasitic origin, and three examples of asymptomatic parasitosis. Eosinophilia is a classical sign accompanying multicellular parasites (helminths). The rate depends on the duration of the disease, the type of parasite and the scale of the infestation. Pathological eosinophilia is usually present before diagnosis is possible; hence it is necessary to repeat laboratory examinations. Several parasitic diseases are asymptomatic and, after a long evolution, cause serious complications. Examples quoted are malaria, for which there is no absolute prophylaxis, amoebiasis, which is responsible for hepatic necrosis in patients who have never had dysentery, and schistosomiasis, which insidiously causes irreversible hepatic necrosis and ureteral stenosis. These conditions are becoming increasingly frequent in our countries and call for closer attention.

[Are physicians also sick? Results of a survey carried out in French-speaking Switzerland and Tessin]. / Les médecins sont-ils aussi malades? Résultats d'une enquête effectuée en Suisse romande et au Tessin.

The results are presented of a study among 466 physicians in French- and Italian-speaking Switzerland concerning their own health. It emerged that 77.7% of the physicians had had at least one disease during the year studied; in 50% of cases the morbidity was linked to stress and emotivity. Cardiovascular pathology was significantly higher than in the average population. The results reveal striking differences between the different categories of physicians: hospital doctors had more cardiovascular diseases and fewer infectious and pulmonary diseases than physicians running a private practice. Psychiatrists have a higher morbidity rate than the average. General practitioners, psychiatrists and surgeons appear to be especially exposed to stress and emotivity. Pediatricians suffer less from this group of diseases but present a morbidity correlated with that seen in practice, suggesting transmission from patient to doctor.

Pseudotumoral enterocolitis and massive eosinophilia.

We report a seven year history of a 23 year old woman born in the Antilles, with pseudotumoral enterocolitis and massive eosinophilia. In 1973 she developed a haemorrhagic colitis with massive peripheral eosinophilia of up to 60000/mm3. Medical treatment, mainly corticosteroids, failed to control the disease. The patient temporarily improved after colectomy and remained in remission for two years. In 1978 the disease recurred in the rectum and small intestine with formation of tumour-like granulomata and massive infiltration by eosinophils, unresponsive to corticosteroids. Intestinal blood and protein loss continued until death seven years after onset. In spite of exhaustive investigation, no parasites, allergens, or other aetiological agents could be found. As only the gut was infiltrated, the hypereosinophilic syndrome could be excluded. The enterocolitis here described does not correspond to an eosinophilic gastroenteritis, nor to other known inflammatory bowel diseases and to our knowledge has not been reported previously.

[Use of drugs in a medical polyclinic]. / L'usage des médicaments dans une policlinique de médecine.

The medical prescriptions of 18 house officers working at the Policlinique Universitaire de Médecine in Geneva were analyzed for a period of 17 working days and provide insight into drug therapy chosen for 2194 outpatients at 2694 consultations. These patients were prescribed an average of 1.39 drugs each or 1.13 per call. Of the 298 different drugs thus prescribed, the following were chosen most frequently (in decreasing order): Digoxin, Hygroton, Lexotanil, Metamucil, Voltaren, Aspirin, different insulins and Aldomet. Antimicrobial agents accounted for only 2.5% of all prescriptions, while vitamins and "fortifiers" represent an even lower percentage. It would be possible to limit the number of drugs, since half of the prescriptions cover 23 drugs and 90% of all prescriptions cover 119 drugs. Prescription patterns vary markedly from one subspecialty of internal medicine to another, but also between physicians working in the same field. House officers in charge of given sectors of the city (internists not working in a subspecialty) may thus prescribe between 1,83 and 2.9 drugs per patient, whereas the number of drugs chosen may vary between 81 and 134. Some quaint individual preferences for drugs were also noted and the trend is analyzed. The data is compared with results of the few existing similar studies and offers food for thought on prescription habits, directed ultimately towards a more rational approach to drug therapy for outpatients.

[Prescription profile in French speaking Switzerland and in the Tessin. Analysis of 2006 medical prescriptions]. / Profil de prescriptions en Suisse romande et au Tessin. Analyse de 2006 ordonnances médicales.

Analysis of 2006 prescriptions given to 641 unselected patients by 360 doctors in the French- and Italian-speaking parts of Switzerland provides a wealth of information on prescription trends and the cost of medicine. The patients ordinarily received medication belonging to several therapeutic groups, usually 2 or 3 but up to 9 different groups. Each prescription averaged 2.08 drugs with a mean cost of 18.90 Swiss francs. The price varied considerably according to the group of drugs. Those related to the cardiovascular system were the most expensive closely followed by antibiotics, while the ophthalmological prescriptions were the least expensive. Hydergine is the most-sold drug in Switzerland, followed by Bactrim; however, if the various benzodiazepines were grouped together their sale would exceed the others. There are 62 different drugs for rheumatic conditions and 47 penicillins in Switzerland. The abundance of drugs and the prescription of medication with dubious action contribute to the inflationary cost of illness. For any given drug there is a striking parallelism between the number of pages publicizing it in 4 medical journals and total sales. This clearly demonstrates the influence of advertising on prescription trends. Doctors should be aware of this fact and rely on more objective sources of their information about drugs.

[Severe colitis with eosinophilia]. / Colite grave avec hyperéosinophilie.

A 23-year-old woman from the French Antilles was successfully treated for intestinal and hepatic schistosomiasis, as evidenced by the normalization of immunofluorescence titers and many negative histogogical controls. She presented, however, persistent colitis with marked eosinophilia (eosinophils in excess of 50,000/mm3). No precise diagnosis could be established in spite of all parasitological, allergological, hematological and gastroenterological investigations. The colon was the only organ involved and showed colitis of a type unclassifiable both endoscopically and histologically. Massive infiltration by eosinophils was present. Temporary relief was achieved with steroids but the clinical condition of the patient became dramatic. Three years after the onset of the illness total colectomy was performed, sparing the rectum. After surgery all manifestations of disease disappeared and for ten months the number of eosinophils was normal. Ileorectal continuity could be re-established. Ten months after reanastomosis there was recurrence of bleeding from the rectum and eosiophils once again reached levels of 2340/mm3. The differential diagnosis of this colitis associated with eosinophilia is discussed. To our knowledge it does not correspond to any clinical entity described so far.

[Amebic liver abscess of unusual presentation]. / Abcès hépatique amibien de présentation inhabituelle

A 35-year-old male who had travelled extensively in the tropics presented with severe anorexia and vomiting associated with fever of 39-40 degrees C during a 4-day period. The clinical findings were entirely negative. In 1973, he had been given metronidazole for amebic dysentery, since when recurrent attacks of diarrhea and abdominal pain had been treated with iodoquinoleines. Stool examination was negative for amebae. Liver scan revealed a suspect "expansive process" in the right lobe. The presumptive diagnosis of amebic abscess was made and metronidazole therapy was started. In less than 24 h the patient became afebrile. The abscess was confirmed by a further liver scan. The definitive diagnosis of amebiasis was established 16 days later when the immunofluorescence level, which had been previously negative, became positive 1/480. This case demonstrates the dangers of the indiscriminate use of iodoquinoleines in patients who have travelled in tropical countries. The amebic liver abscess may be silent locally while causing systemic manifestations such as fever. Early treatment of hepatic amebiasis is recommended even with a presumptive diagnosis. Serological tests during the development of an amebic abscess may be negative and should be repeated after several days of therapy.

[18 cases of anguilluliasis diagnosed at Geneva]. / A propos de 18 cas d'anguillulose diagnostiqués à Genève

Eighteen cases of strongyloidiasis have been diagnosed in Geneva, Switzerland, since the laboratory method of Baërmann was introduced. Digestive disorders were reported by 15 patients, and pulmonary symptoms were present in 4. Six also had various neurological symptoms. Peripheric eosinophilia was above 5% in all cases and above 10% in 14. A single course of treatment with thiabendazoled 17 patients, while the last was cured after a second course. Three of our 18 patients were infected in Geneva and had never travelled abroad.