[Periodic health examination: a collaboration between an academic institution, a private firm and general practitioners]. / Collaboration médecins praticiens et entreprise privée pour une consultation préventive "Bilan de santé": une expérience romande.

A Swiss private company decided to launch a healthy lifestyle-oriented medical visit for its employees. Participating general practitioners had prior training through a one-day course. A brief physical examination, cholesterol and glucose analyses were included in the consultation. Half of the employees participated in the project. Health habits were similar to the general Swiss population. Four months later, 61% reported having changed at least one lifestyle health habit in order to improve their health. Most of participants and practitioners were satisfied with this type of consultation, that confirms the interest and the feasibility of such a project.

One-year mortality among unselected outpatients with heart failure.

OBJECTIVE: To estimate 1-year mortality and prognostic factors in unselected outpatients with heart failure, and to compare the observed mortality with the estimates of the primary care physicians. METHODS AND RESULTS: Four hundred and eleven consecutive patients with heart failure New York Heart Association (NYHA) class II-IV (mean population age 75 years, 56% males) were enrolled in 71 primary care offices throughout Switzerland. During a mean follow-up period of 1.4 years, 68 patients had died. One-year total mortality was 12.6% compared to 4.3% in the underlying Swiss population (standardized mortality ratio 3.0). Among patients with heart failure NYHA II, III and IV, mortality was 7.1%, 15.0% and 28.0%, respectively. In multivariate Cox regression, statistically significant (P<0.05) predictors of mortality were NYHA class (NYHA III: risk ratio [RR]=1.6; NYHA IV: RR=2.2), recent hospital stay for heart disease (RR=2.3), creatinine>120 micromol.l(-1) (RR=1.8) systolic blood pressure<100 mmHg (RR=2.4), heart rate>100 min(-1) (RR=2.7), age (per 10 years, RR=1.6) and female gender (RR=0.49). Among patients with reduced left ventricular ejection fraction, 1-year mortality was 14.3%, and predictors were similar except that female gender was no longer associated with reduced mortality. Primary care physicians significantly overestimated 1-year mortality (estimated mortality 25.9% vs observed mortality 12.6%,P =0.001). CONCLUSIONS: Unselected outpatients with heart failure have a poor prognosis, particularly those with advanced heart failure and a recent hospital stay for heart disease. Primary care physicians are aware of the high mortality of this growing patient population.

[Research in general practice. Plea for organized and high quality clinical research by general practice physicians in Switzerland]. / Forschung in der Praxis. Plädoyer für eine organisierte und qualitativ hochstehende klinische Forschung praktizierender Arzte in der Schweiz.

The clinical research in the practitioner's office is indispensable for the teaching of the medicine of first recourse. On the basis of the analysis of 109 publications, the authors propose to structure this research under the shape of investigator's networks while guaranteeing an interface between the primary care physicians and the academic specialists. To realise this network, an institutional support is necessary.

[Hypotensive effect of an inhibitor of cholesterol synthesis (fluvastatin). A pilot study]. / Effet hypotenseur d'un inhibiteur de la synthèse du cholestérol (fluvastatine). Etude pilote.

To investigate whether fluvastatin lowers cholesterol and blood pressure in hypertensives and hypercholesterolemic patients, 23 patients followed by their medical practitioner received 40 mg fluvastatin once a day for 12 weeks. Arterial blood pressure was measured by continuous ambulatory monitoring. Total mean cholesterol (mmol/l) was lowered from 7.98 +/- 1.21 to 6.25 +/- 0.88 and the atherogenic index from 7.26 +/- 2.11 to 5.49 +/- 1.35. Mean arterial systolic and diastolic blood pressure (mm Hg) was reduced from 144.8 +/- 13.7 to 138.6 +/- 18 and from 97.3 +/- 9.1 to 92 +/- 10.8. In responders (n = 12), blood pressure decreased from 142.6 +/- 11 to 126.4 +/- 11.1 and from 99.6 +/- 7.1 to 88.3 +/- 6.5. In conclusion, fluvastatin prescribed in a dose of 40 mg/day for 3 months to 23 hypertensives and hypercholesterolemic patients lowers the cholesterol level and lowers blood pressure. Lowering of blood pressure is independent of lowering of cholesterol.

[Importance of the clinical profile in the postmenopausal osteoporosis screening by densitometry]. / Importance du profil clinique dans le dépistage de l'ostéoporose postménopausique par densitométrie.

In order to test the impact of a given risk profile on the incidence of osteoporosis which could justify BMD measurement, and that of a low risk profile which could render it unnecessary, BMD was measured in 217 women under 72 in whom menopause had occurred at least 6 years previously and who corresponded to one of the two following profiles: high risk (A, n = 102) = BMI < 27 kg/m2, with no estrogen replacement treatment, and with at least one of the following risk factors: BMI < 20, early menopause, positive family history, no dairy products associated with tobacco consumption (> 10 cigarettes/day for > 20 years and/or alcohol consumption of > 0.5 l wine/day during > 10 years, corticotherapy of > 6 months, rickets, anorexia nervosa. Low risk (B, n = 115) = absence of characteristics of group A, BMI > 27 kg/m2 with (B+, n = 24) or without estrogen therapy (B-, n = 91). BMD was measured by DXA in 4 centers using Lunar or Hologic equipment. Results were expressed in % of the mean of the respective young adult control groups. As expected, BMD was significantly different in these two subgroups of the population. Osteoporosis was diagnosed (BMD < 75% = < -2.5 SD, according to WHO) in 72% of group A, and in 17% (B+) and 19% (B-) respectively of group B. There was no difference between the various risk factors in group A concerning their impact on BMD, but concerning incidence, low BMI and early menopause were the most frequent. The high risk profile of group A seems to justify densitometry, since it leads to the diagnosis of osteoporosis in over 70%. However, the protective profile of group B does not exclude osteoporosis (risk still 20%); only in severe obesity (BMI > 33) does it drop to 1%.

[Association of a giant Meckel's diverticulum and Crohn disease of the neighboring intestinal segments]. / Association d'un diverticule de Meckel géant et d'une maladie de Crohn des segments de grêle avoisinants.

We report the case of a 51-year old patient presenting a giant Meckel's diverticulum associated with Crohn's disease in the proximal and the distal segments. The voluminous diverticulum had already been demonstrated by radiographies at the age of 28 years. Late symptoms were signs of partial obstruction and malabsorption.

[Evaluation of the 24-hour effect of a once-daily antihypertensive drug on the diurnal blood pressure profile]. / Evaluation par profils tensionnels diurnes de l'activité sur 24 heures d'un médicament antihypertenseur administré une fois par jour.

The efficacy and duration of action of antihypertensive drugs can be objectively investigated by means of non-invasive 24-hour blood pressure profiles. Nocturnal measurements, however, are at times not well accepted by the patients, due to the sleep disturbances which may occur, and the results may therefore be difficult to interpret. To overcome this problem we used diurnal (8 am to 10 pm) profiles in the study of the efficacy of isradipine SRO (5 mg). 22 patients were included in this open, cross-over study; isradipine was given at either 9 am or 9 pm. The results demonstrate that isradipine SRO lowers blood pressure over a period of 24 hours. The magnitude of this effect is reduced, however, 22 or 13 hours (for systolic and diastolic blood pressure respectively) subsequent to ingestion of the drug. In conclusion, we have shown that diurnal blood pressure profiles minimize the risk of incomplete recordings and render the investigation more acceptable to the patient. The methodology is, therefore, practical and useful in daily medical practice.

[Evaluation of a new ambulatory blood pressure measuring device, the Sandoz Pressure System]. / Evaluation d'un nouvel appareil tensionnel ambulatoire, le Sandoz Pressure System.

The accuracy of "Sandoz Pressure System", in comparison with the mercury sphygmomanometer, was studied in 171 patients in 2 centers. The correlation, as estimated for 657 pairs of measurements, was excellent: systolic and diastolic coefficients were r = 0.986 and r = 0.940 respectively. The individual difference is less than or equal to 5 mm Hg for 90% of the systolic values and 82% of the diastolic values. The ambulatory reliability is demonstrated for 300 profiles, of which 279 (93%) are complete. Of 7902 determinations, 59 (0.75%) were deleted because considered to be incorrect.

Evaluation of the antihypertensive effect of a beta-blocker with the aid of daily blood pressure profiles.

The clinical efficacy of bopindolol, a new, long-acting beta-adrenoceptor blocking drug, in a dosage of 1-2 mg daily was compared with that of atenolol (50-100 mg daily) in 33 patients with mild or moderate arterial hypertension who were treated for a total period of 12 months. Both drugs lowered systolic and diastolic blood pressure to about the same extent, but atenolol caused a somewhat greater lowering of heart rate. Over 70% of patients receiving atenolol required a diuretic in addition, whereas only 55% of the bopindolol patients required a diuretic. Both drugs maintained 24-h blood pressure reduction with once-daily therapy, although circadian rhythm (recorded using a Remler device) tended to be lost during treatment with atenolol but not with bopindolol.

Data analysis of long-term blood pressure monitoring.

Long-term blood pressure monitoring provides a large quantity of data with a wide inter-individual or inter-group variability. The conventional "mean/standard deviation" approach to data analysis is a relatively insensitive instrument for detecting circadian differences in blood pressure profile, mainly because the mean and the variability around the mean are processed separately. The proposed Standardized Systolic and Diastolic Scoring (SSDS) method enhances the analytical possibilities. Preliminary evaluation of the SSDS method using data obtained in an anti-hypertensive drug trial suggests clinical relevance.

[Value of a blood pressure profile in evaluating 2 antihypertensive agents]. / Intérêt du profil tensionnel dans l'évaluation de deux antihypertenseurs.

Bopindolol (Sandoz) in single daily doses of 1 and 2 mg was compared with atenolol (ICI) in single daily doses of 50 and 100 mg in respect of antihypertensive effect in a population of 33 patients divided by random allocation into 4 groups and treated for 12 months. Statistical analysis of the more than 4000 blood pressure readings obtained with a noninvasive ambulatory blood pressure recorder indicates equivalence of efficacy between bopindolol 1 mg, bopindolol 2 mg and atenolol 100 mg, with atenolol 50 mg less effective. Bopindolol's long duration of effect was reflected in lower morning values and in the absence of hypotension in the circadian profile.