[Bilateral axillary nodes. 30-year-old patient, housewife]. / Axilläre bilaterale Knoten. Patientin, 30-jährig, Hausfrau.

A 20-year old patient who had been adequately treated for lymph node tuberculosis 14 years ago presented 1 week after giving birth to a healthy daughter. She complained about painful lumps in both axillae. During pregnancy the patient suffered from hyperemesis gravidarum, lost 6 kg of weight, and had night sweats. During the last three months of her pregnancy she had a deep vein thrombosis in her right lower leg. The clinical examination showed soft axillary lumps up to 3 cm. The lab showed the following pathological findings: blood sedimentation rate 51 mm/h, CRP 44.8 mg/l, LDH 221 U/l and INR 1.3 (indicating insufficient anticoagulation with phenprocoumon). The chest x-ray showed no infiltrate or indications of a past tuberculosis. A fine needle aspiration cytology was performed on an accessible node. Gram stain, Ziehl Neelsen stain, as well as the bacteriological cultures were all negative. An ultrasound examination of the axilla showed a thickened subcutis without a mass. Cytology showed lobular epithelium, consistent wih ductal mamma epithelium without atypical cells. The diagnosis of an accessory mamma tissue in both axillae was made. During the course of the following weeks the glands decreased in size and the patient was free of symptoms.

[Bronchitis, pregnancy test and hematuria--an atypical algorithm for diagnosis]. / Bronchitis, Schwangerschafts- test und Hämaturie--ein atypi- scher Algorithmus zur Diagnose. 42-jährige Hausfrau mit trockenem Husten.

A 42-year old housewife presented herself with flu symptoms and dry cough. Because of pregnancy test (chest x-ray) we accidentally detected a hematuria. Exact medical history revealed the presence of a known IgA-Nephropathy. Banal respiratory infections can exacerbate IgA Nephropathy. In addition, medical history and further investigations are important because of possible secondary IgA-Glomerulonephritis. Treatment of IgA glomerulopathy depends on blood pressure, renal function and degree of proteinuria. An acute renal insufficancy is uncommon (< 5%), but 25% patients develop during 20-25 years a terminal insufficandy.

[Inguinal swelling and ankle edema after inguinal hernia operation]. / Leistenschwellung und Knöchelödem nach Inguinal- hernien-OP.

We diagnosed an aggressive Non-Hodgkin-Lymphoma (diffuse large B-cell lymphoma, DLBCL) in a patient with a fast growing inguinal mass. Only one third of all suspicious inguinal lymph nodes that are investigated histologically are found to be malignant lymphoma. If so, an accurate histopathological evaluation of sufficient neoplastic tissue is critical. Prognosis in DLBCL is highly associated with the IPI score. Overall survival has been improved by the CHOP-R regimen established in 2002, with a disease-free survival exceeding 50%.

[Unilateral neck inflammation in psoriasis]. / Unilaterale Halsschwellung bei Psoriasis.

Local inflammation and systemic symptoms such as fever, fatigue and loss of appetite suggest the diagnosis of an abscess even if the patient is in a good general physical condition. The site of bacterial penetration should be identified along the corresponding lymphatic vessels. In this case, periauricular scratching induced by severe psoriasis led to a cervical abscess, the causing bacteria were identified as Streptococcus pyogenes.

[Cutaneous coagulase-negative staphylococci--always harmless?]. / Koagulase-negative Staphylokokken auf der Haut--immer harmlos?

Staphylococcus lugdunensis belongs to the group of coagulase-negative staphylococci, but share many clinical and microbiological characteristics with Staphylococcus aureus. We report two cases of chronic recurrent purulent skin infections in two females (one immunocompetent, the other HIV-infected with CD4 cell counts of 438/microl) who were treated repeatedly with antibiotic and surgical interventions, but only became free of recurrences after this was combined with a decontamination strategy.

[Reconstruction or amputation in complex fractures of the tibia. A comparative study with special reference to insurance medicine aspects]. / Rekonstruktion oder Amputation bei komplexen Unterschenkelfrakturen. Eine vergleichende Studie unter besonderer Berücksichtigung versicherungsmedizinischer Aspekte.

As an introduction to the subject, a historical retrospective review of the pension-related outcome of fractures of the tibia and fibula is presented. Analysis of the past 50 years shows a continuous reduction in the frequency of the award of pensions in such cases, from 36% to 2.2%. A retrospective Swiss study is then presented, in which 18 patients with below-the-knee amputations are compared with 21 patients with limb-salvage of the lower leg. Medical insurance parameters such as length of hospitalisation, number of operations, duration of rehabilitation and the level of rehabilitation achieved, with the degree of functioning of the leg and any occupational changes are considered, and finally the frequency of the award of pensions and the costs involved are determined and compared. According to these results, better overall functioning of the leg can today be achieved in the cases with successful limb-salvage; when costs are compared, taking into account the pension costs, in this Swiss study limb-salvage is the most economical solution. These results are in contrast to an American study which shows a medically and economically more favourable outcome in the case of amputations. In order to obtain better results with the costly limb-salvage procedures, improvements and advances in diagnosis, surgical techniques and rehabilitation are required. These requirements from the American study can be endorsed although, the Swiss study presents more favourable results. Both studies cover very heterogeneous patient populations and may be compared only conditionally.

[Skiing accidents in the Swiss Accident Insurance Service, social sequelae and prevention]. / Skiunfälle bei der SUVA. Epidemiologie, soziale Folgen und Prophylaxe.

The epidemiology of skiing accidents is described and discussed on the basis of SUVA statistics. This is followed by an analysis of the frequency of the various types of injuries and a summary of the social consequences (cost of treatment, daily sickness allowance, compensation for pension and integrity compensation). To conclude, there is a discussion on the prevention of skiing accidents and, in particular, the presentation of "warm-up!", SUVA's prevention campaign. This campaign has been designed to the very latest advertising principles to prevent skiing accidents. It addresses the question of the correct warming-up procedures at pan-Swiss level prior to undertaking a downhill skiing run.

["Warm-up!" Prevention of skiing accidents. A preventive campaign by the Swiss Accident Insurance Organization]. / "Warm-up!" Verhütung von Skiunfällen. Eine Präventionskampagne der SUVA.

In 1991, 762,800 leisure time accidents were recorded in Switzerland. 33% of the accidents occurred in the course of a sporting activity with the majority happening while playing football. Skiing accidents came second. Although the recession reduced the number of accidents, skiing accidents were on the increase. The number of all other leisure time accidents including football accidents (the largest group) declined, as did occupational accidents. In terms of medicine, insurance and the economy, the significance of more than 54,000 skiing accidents each year is enormous. SUVA, the Swiss National Accident Insurance Organization is launching a comprehensive campaign to prevent skiing accidents. Among the many methods of prevention possible, such as physical preparation prior to the skiing season, safe equipment, correct skiing technique, consideration for other slope users and adaptation to the snow conditions, etc., this campaign focuses on the avoidance of a cold start. The campaign, which is planned to last several years and will cover the whole of Switzerland, aims to propagate the warm up before setting off downhill. The concept and development of this large-scale, professionally-run SUVA preventive campaign are described.

[Shoulder dislocation and periarthrosis humeroscapularis]. / Schulterluxation und Periarthrosis humeroscapularis.

1232 injuries involving shoulder luxations in 1984 were investigated on the basis of the insurance dossier. 1/3 of the injured persons have sequelae: 10.5% habitual tendency to luxation, 9% peritendinitis, 2% omarthritis and 2% a shoulder instability. 1/5 in each case still experience pain and restricted movement. The 108 cases where peritendinitis has occurred following shoulder luxations are shown divided up according to various symptoms. Peritendinitis ankylosis or frozen shoulder represents the major share in almost half of the cases. Various characteristics, complications and risk factors for the possibility of contracting peritendinitis following shoulder luxation are being worked out. In conclusion, the insurance-relevant parameters for peritendinitis after shoulder luxation are shown: in cases with peritendinitis, integrity compensation was awarded 12 times more frequently than in cases without peritendinitis; in the case of shoulder luxation with peritendinitis, the entire insurance benefits were 10 times higher than in cases without peritendinitis.

[Posterior shoulder dislocation in a patient sample of the Swiss Accident Insurance Service]. / Hintere Schulterluxationen im Patientengut der SUVA.

We report on 17 posterior shoulder dislocations which were investigated by SUVA's medical service during the past three years. We can confirm the information in the literature, that the diagnosis is initially often missed (4 out of 17) and that the injury is often sustained in epileptic fits (4 out of 17). Among our patients, however, the time at which the diagnosis was made did not obviously influence the results of the treatment. After treatment, over half of our patients have an impairment which, in three cases, resulted in integrity compensation, in one case in a recommendation for vocational retraining, in one case in a change of profession and in one case in a pension.

[Insurance medicine and accident surgery]. / Versicherungsmedizin und Unfallchirurgie.

A definition of insurance medicine is presented with due consideration for national peculiarities (social insurances) in Switzerland. The historical development from original trauma-directed accident medicine to the present-day insurance medicine with its more comprehensive nature is shown with particular consideration being given to the close connection with traumatology (trauma surgery/orthopaedic surgery). The guarantee of smooth-running and constructive cooperation between traumatologists and welfare organizations is one of the major tasks of doctors employed in insurance companies, whose sphere of influence and qualifications are under discussion.

[Prevention of serious injuries due to bicycle riding]. / Zur Prophylaxe schwerwiegender Verletzungen durch Fahrradunfälle.

In 1984 there were 32,860 persons who suffered from bicycle-related injuries in Switzerland. They accounted for 27% of the persons injured on the road. Cranio-cerebral trauma had to be treated in 26% of the injured bicyclists. Two thirds of hospital admissions after bicycle accidents were due to head injuries. Craniocerebral trauma accounted for about 65% of the residual lesions and for 69% of the lethal injuries related to bicycle accidents. A relatively simple and effective protection for these injuries would consist of the use of a helmet. To estimate the expected reduction of head injuries if everybody had a helmet, the regression analysis of a previous study from Seattle was applied. By wearing hard-shell helmets, there would be a reduction in number and severity of 7500 head injuries and a decrease of 2000 hospital admissions each year in Switzerland. In addition to the decrease in suffering and quality of life of the use of helmets would lower health costs by at least 22 million swiss francs per year.

[Statutory accident insurance--obligatory social accident insurance in Switzerland]. / Gesetzliche Unfallversicherung--Die obligatorische soziale Unfallversicherung in der Schweiz.

According to the new Accident Insurance Law, in Switzerland it is mandatory for all employees to be insured against accidents and occupational diseases. The legal bases, organization and implementation of this mandatory social accident insurance are described. Discussed in particular are the specific Swiss features, such as the inclusion of non-occupational accidents (leisure-time accidents), and special medical aspects in the assessment of incapacity, injury and occupational diseases.

[Street traffic accident--whiplash injury of the cervical spine from the viewpoint of insurance medicine]. / Strassenverkehrsunfall--Das Schleudertrauma der Halswirbelsäule aus versicherungsmedizinischer Sicht.

The Swiss Accident Insurance Institute (SUVA), as the largest mandatory insurer against accidents in Switzerland, handles approximately 3000 cases of injury to the cervical spine every year, half of which are the result of traffic accidents. A considerable proportion of these involve whiplash injuries to the cervical spine. Epidemiological and statistical results according to this medical definition and based on material collected over a period of several years are presented. The assessment of these cases from the medical insurance point of view is discussed. Mild whiplash injuries are very common and as a rule they heal without sequelae. Severe whiplash injuries with massive soft-tissue damage and fractures are rare and present few problems for the causality assessment. Problemtical, on the other hand, are the not infrequent cases of whiplash injuries which initially seem to be ordinary sprains but which subsequently develop into lasting clinical syndromes that are very difficult to objectify. Further, the assessment and care of these problem cases in particular are discussed from the medical insurance point of view. In these patients, who suffer severe pain and discomfort, it is in most cases not possible to obtain any objective findings with the classical diagnostic measures of radiology, orthopaedics and neurology. They can very soon be suspected of malingering, exaggeration or pension neurosis. Only with the very sophisticated, modern diagnostic methods of neuropsychology, chiropraxis and functional computed tomography is it sometimes possible to objectify these syndromes in a reproducible manner and possibly to establish a post-traumatic instability as the cause. This then again opens up promising possibilities for the treatment of these patients. The SUVA supports research aimed at developing and testing such promising new methods of examination. However, it at the same time warns against the uncritical use of these expensive methods of examination, the informative value and the scientific validity of which are in some respects still not sufficiently well established.

[Hazardous sports and insurance]. / Risikoreicher Sport und Versicherung.

In spite of increased efforts in the prevention of recreational accidents the SUVA has to state that, as before, there is a steady increase in non-occupational accidents. 33% of all non-occupational accidents are caused through sport. Preventive measures and optimum patient treatment are effective moves to limit the costs. Shortening the financial benefits in heavy-risk sports (hazardous ventures) or in grave infringement of elementary cautionary obligations (gross negligence) should aim less at a cost saving than at an overall preventive effect.

[Back injuries and the work site]. / Rückenschäden und Arbeitsplatz.

Payments through obligatory accident insurance for back injuries as a result of an accident in the legal sense are common. In contrast, the acceptance of back injuries as an occupational illness is associated with such strict legal prerequisites that, considering the early appearance and frequency of degenerative back diseases in the general population, the condition whereby a back injury must have been caused exclusively or predominantly, i.e. at least three quarters, by the occupational activity is satisfied only in rare cases. Epidemiological studies show that back conditions occur more frequently in certain types of exposed occupation. The high degree of causality required by the legislature is, however, not demonstrated so that back injuries could therefore be recognized as occupational illnesses only in rare cases. Because of this, prevention at the place of work is all the more important.