Multiple hepatic and brain abscesses caused by Parvimonas micra: A case report and literature review.

Gram-positive anaerobic cocci (GPAC) are responsible for 30% of anaerobic infections. Parvimonas micra is an emergent pathogen that is part of the oral and gastrointestinal commensal flora, and its role in several infection processes has recently emerged thanks to the improvement of diagnostic techniques. P. micra bacteraemia is reported in immunocompromised patients and is often complicated by abscesses. Here, we present a case study of multiple hepatic and brain abscesses caused by P. micra bacteraemia in a patient with complicated diverticulitis.

Doxium 500 in chronic venous insufficiency: a double-blind placebo controlled multicentre study.

The aim of this double-blind placebo-controlled study was to evaluate the therapeutic efficacy of Doxium in chronic venous insufficiency (CVI). 225 patients were treated randomly for 4 weeks with 1.5 g (3 capsules/day) of Doxium or placebo. The evolution of the leg oedema was determined by measuring calf and ankle circumferences. Pain and discomfort were assessed by visual analogue scale. The results show that at the end of the trial, all the examined parameters (leg oedema, pain, day and night cramps, discomfort, heavy legs, paresthesia and restless legs) were significantly more improved in the Doxium group than in the placebo group: the leg volume was diminished by 3.8% in the Doxium group compared to 1.2% in the placebo (p less than 0.005). The overall assessment by the physicians showed an improvement in 82% of the Doxium-treated patients compared to 42% of the placebo group (p less than 0.0001). The tolerance of the treatment was comparable in both groups.

[The course of varicose disease. Parallel retrospective study of 2 ethnic groups (Catania-Basel)]. / Curso de la enfermedad varicosa. Estudio retrospectivo en paralelo entre dos diferentes grupos étnicos (Catania-Basilea).

Authors presents a retrospective study with two different ethnic groups, one of them from Catania and the other from Basilea, with varicose veins and subjected to a saphenectomy. They studies the following parameters: age at the entrance, and when varicose veins appeared; correlation between varix appearance date and subjective symptomatology; and rapport between varix complications and its duration. The possible incidence of "ambiental factor" and contrasts between the two groups are considered.

[Thrombosis in a probable double heterozygote young man from an asymptomatic family with protein C deficiency and protein C dysfunction]. / Thrombose bei einem wahrscheinlich doppelt-heterozygoten jungen Mann aus einer asymptomatischen Familie mit Protein-C-Mangel und Protein-C-Dysfunktion.

A family with combined quantitative and qualitative protein C deficiency is presented. The probably double heterozygote propositus with 7% residual amidolytic protein C activity had deep leg vein thrombosis at the age of seventeen. Other family members were asymptomatic.

[Varices, a true disease?]. / Des varices, une vraie maladie?

There is little agreement on the real prevalence and significance of varices of the lower limbs. The discrepancies between the data produced by the various studies are attributable to several factors, of which the most important has to be the absence of any definition of the forms and types of varices. In the Basle study there has been an attempt to classify into two groups, "disorder" and "disease", according to the severity of the clinical picture. These two groups are clearly distinct regarding complications and the number of risk factors. A study on the long-term development has also shown that at the end of 11 years the group "disease" more frequently presented socio-medical after-effects than the group "disorder". Pronounced varices therefore do constitute a real disease and merit appropriate attention.

[Quantitative and qualitative hemostatic changes in 373 patients with recurring venous thromboses]. / Quantitative und qualitative Hämostaseveränderungen bei 373 Patienten mit rezidivierenden Venenthrombosen.

Extensive haemostasis analysis in 373 patients with recurrent idiopathic venous thrombosis revealed insufficient fibrinolysis activation by the venous occlusion test in 48%. A case with antithrombin III dysfunction was the only inherited anomaly.

Incidence and course of occlusive peripheral artery disease in geriatric patients. Possibilities and limits of prevention.

The fate of patients with chronic and acute OPAD was analysed in order to delimit needs and limits of preventive measures. Chronic disease. A high 5 year incidence of OPAD and a strong correlation with the risk factors at entry was observed in 2630 men initially free of disease. The incidence was at 114% in men with 3 risk factors vs 20% in the subgroup free of risk at entry. In a 11 year follow-up study of 239 men with OPAD a high mortality of 37% was observed vs 13% in the age-matched randomized controls. Death was due to coronary heart disease (CHD) in 15.1% of OPAD vs 1.7%. The mortality was significantly correlated with the risk profile at entry 46% in persons with several risk factors vs 19% in those free of risk. The strong correlation between the risk profile and morbidity/mortality indicates that primary prevention by reduction or elimination of risk factors could successfully avoid or postpone CHD and OPAD, if started early and not only at the threshold of the 3d life. Acute disease. The analysis of a geriatric subgroup, 141 patients older than 70 years, demonstrated that acute artery occlusion is a limb-and life-threatening event with an in-hospital mortality of 33% and an amputation-rate of 19%. Life together with limb salvage was obtained, in spite of thrombectomy thrombolysis or anti-coagulants, in only 57%. The subgroup at increased risk could have been recognised in advance by antecedent atrial fibrillation, OPAD and/or myocardial infarction; 50% presented indeed with several, 33% with one and only 17% without the mentioned conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiology of arterial occlusive disease. Peculiarities in advanced age]. / Epidemiologie der arteriellen Verschlusskrankheit. Besonderheiten im höheren Lebensalter.

Based on data of the Basle Study and on a trial of 225 patients with acute arterial occlusion, findings of frequency and the fate of patients with OPAD are presented. The prevalence of asymptomatic OPAD is three times higher than the symptomatic form with intermittent claudication. This is true especially in older people with concomitant diseases such as CHD masking the claudication. Thus, trophic lesions or acute occlusion may occur unexpectedly. However, patients at risk should be detected at an early stage by non-invasive methods and by the risk profile. Acute arterial occlusions show an impressive symptomatology and are followed by severe consequences: in-hospital mortality was 33% and amputation had to be performed in 19%. In older patients with known disposing diseases acute occlusion can often be avoided by prophylactic measures.

Fibrinogen, factor VIII related antigen, antithrombin III and alpha 2-antiplasmin in peripheral arterial disease.

In 306 subjects, 217 without and 89 with peripheral arterial disease (PAD), VIIIR:Ag and alpha 2-antiplasmin are significantly higher in PAD (p less than 0.01). In the PAD negative group the ratio alpha 2-antiplasmin/antithrombin III activity is significantly higher 1.11 +/- 0.3 in the patients with an abnormal exercise ECG typical of coronary disease than in normal subjects 1.02 +/- 0.2 (p less than 0.05). In the PAD positive group antithrombin III concentration is higher in patients with a normal exercise ECG than in patients with abnormal exercise ECG (p less than 0.05). The same is true for alpha 2-antiplasmin but not for the antithrombin III activity. Fibrinogen and VIIIR:Ag are higher in patients with a previous myocardial infarction, however, the age is also significantly different as compared to the group without previous myocardial infarction. Disturbance of the cerebral arterial circulation is characterized by an elevation of VIIR:Ag and of alpha 2-antiplasmin as compared to the values obtained in patients without this complication. There is a general tendency towards higher alpha 2-antiplasmin values with the extension of the arterial disease.

[The importance of peripheral-arterial occlusive diseases in medical practice. Conclusions from the Basel study]. / Zum Stellenwert der peripher-arteriellen Verschlusskrankheit in der Praxis. Folgerungen aus der Basler Studie.

Based on prospective epidemiological studies, tentative conclusions concerning the place of occlusive peripheral artery disease ( OPAD ) in general practice are presented. For men aged 35-64 the 5-year incidence of OPAD was found to be 76%, i.e. 3 times higher than that of intermittent claudication. In a high percentage of cases new occurrences of OPAD were predictable by the risk profile at entry. Men with 3 risk factors had an incidence of 114% compared to 20% in those free of risk at entry. A comparative 11-year follow-up of 273 men with OPAD and 273 age-matched, randomly selected controls without OPAD , revealed a moderate incidence of local complications (3% amputations) but an impressive excess mortality of 33% vs 11%, mainly due to coronary heart disease. The high correlation between the risk profile on the one hand and morbidity/mortality on the other emphasizes the need for action against risk factors. The efficacy of measures for the improvement of the risk profile and the reduction of cardiovascular mortality is discussed on the basis of the so-called " Mister Fit Study".

[Systemic thrombolysis of arterial occlusions of the lower extremities. Comparison of various treatment schedules]. / Systemische Thrombolyse arterieller Verschlüsse der unteren Extremitäten. Vergleich verschiedener Behandlungsschemata.

From 1971-1982 121 patients with arterial occlusions of the lower limbs underwent systemic thrombolysis treatment at the Kantonsspital Basel. During 4 time-periods, 3 different treatment schedules were evaluated consecutively: a) individually titrated high dose streptokinase (SK), b) individually titrated low dose SK and c) p-plasmin, followed by low dose SK-infusion. Thrombolytic success rates did not differ significantly with the 3 treatment schedules. Nevertheless, the p-plasmin-SK scheme tended to the thrombolytically more effective (68%) than high-dose (58%) or low-dose (50%) SK. The most frequent side effects were bleeding complications. In 6 out of the 121 patients, intracranial bleeding occurred and was lethal in 1 of the patients. The incidence of this most serious complication of 4/47 during the sequential p-plasmin-SK schedule led the authors to abandon this scheme for the treatment of arterial occlusions. The intracranial bleeding complications are much less frequent in patients with deep venous thrombosis undergoing systemic thrombolysis, and hence seem to be due in part to the generalized arteriopathy often present in patients with arterial occlusions. The p-plasmin-SK schedule induced the strongest systemic proteolysis in the light of thromboplastin time and factor V values. Comparison of these data with those of other authors is very difficult because of differences in patient selection, treatment schedules and observance of contraindications. The serious prognosis for patients with acute arterial occlusions, with an overall hospital mortality of 26% (experience at the Kantonsspital Basel, 1978-1982) relativizes the importance of the side effects due to systemic thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)