A randomised controlled trial of placebo, droperidol or ondansetron to prevent nausea and vomiting after tonsillectomy in children receiving dexamethasone.

We tested whether prophylactic droperidol and ondansetron, in combination with a moderate dose of dexamethasone, were equally effective in reducing nausea and vomiting after tonsillectomy in children and that both were superior to saline with dexamethasone. We randomly allocated 300 children to intravenous saline, droperidol 10 µg.kg-1 or ondansetron 150 µg.kg-1 , after induction of anaesthesia and the administration of intravenous dexamethasone 250 µg.kg-1 . The rates (95%CI) of nausea or vomiting within 24 postoperative hours were: 42/91 after saline, 46% (36%-57%); 43/87 after droperidol, 49% (39%-60%); reduced to 18/84 by ondansetron, 21% (13%-32%), p < 0.001. There were no differences in the rates of side-effects between groups. We conclude that ondansetron is more effective than saline in preventing nausea or vomiting after paediatric tonsillectomy when given with a moderate dose of dexamethasone, whereas droperidol was not.

[Pediatrics. The PAT: a simple and rapid tool for the assessment of the severely ill or injured child]. / Pédiatrie. 2. Le TEP: outil de triage recommandé pour l'évaluation de l'enfant gravement malade ou accidenté.

The Pediatric Assessment Triangle (PAT) has become the cornerstone for the assessment and treatment of a critically ill or injured infant/young child. Now incorporated to the PALS course, it can be taught to all levels of health care providers in charge of severly-ill children. The PAT is a rapid and simple observational tool suitable for pediatric assessment regardless of complaint or underlying diagnosis. It can be introduced in every emergency department, especially those having relatively infrequent encounters with very sick children. Implementation of such a tool needs formal theoritical and practical education skills, rapid availability of experienced pediatric seniors and spaces specifically intented for children.

Impact of migration on illness experience and help-seeking strategies of patients from Turkey and Bosnia in primary health care in Basel.

Migration, particularly among refugees and asylum seekers, poses many challenges to the health system of host countries. This study examined the impact of migration history on illness experience, its meaning and help-seeking strategies of migrant patients from Bosnia and Turkey with a range of common health problems in general practice in Basel, Switzerland. The Explanatory Model Interview Catalogue, a data collection instrument for cross-cultural research which combines epidemiological and ethnographic research approaches, was used in semi-structured one-to-one patient interviews. Bosnian patients (n=36) who had more traumatic migration experiences than Turkish/Kurdish (n=62) or Swiss internal migrants (n=48) reported a larger number of health problems than the other groups. Psychological distress was reported most frequently by all three groups in response to focussed queries, but spontaneously reported symptoms indicated the prominence of somatic, rather than psychological or psychosocial, problems. Among Bosnians, 78% identified traumatic migration experiences as a cause of their illness, in addition to a range of psychological and biomedical causes. Help-seeking strategies for the current illness included a wide range of treatments, such as basic medical care at private surgeries, outpatients department in hospitals as well as alternative medical treatments among all groups. Findings provide a useful guide to clinicians who work with migrants and should inform policy in medical care, information and health promotion for migrants in Switzerland as well as further education of health professionals on issues concerning migrants health.

[Transportation of patients in the prehospital phase: education of physicians]. / Transport des patients en phase préhospitalière: formation des médecins.

Pre-hospital emergency medicine is developing in Switzerland. At present, however, there is no training standard for this specific and sometimes confusing aspect of extra-hospital activity. Some of the training courses which exist in other countries are recalled and the number of emergency medical transportations in Switzerland is estimated. The training programs of fourteen Swiss hospitals which cooperate with ambulance or helicopter rescue services are then presented. An enquiry by the Centre Hospitalier Universitaire Vaudois (CHUV) among 46 physicians participating regularly in Swiss Air Rescue (REGA) helicopter operations shows the very varied pathology involved and the problems encountered in creating a training program of this kind.

[Cytostatic pneumopathy following chemotherapy for metastasizing breast neoplasm]. / Zytostatika-Pneumopathie nach Polychemotherapie wegen metastasierenden Mammakarzinoms.

A 69-year-old patient treated with anticancer polychemotherapy for metastatic breast carcinoma died of respiratory distress and cardiac failure 3 months after commencement of therapy. At autopsy only a few pleural micrometastases were found. Microscopic study revealed early lung lesions due to cytotoxic drug treatment. While the earlier literature described different lesions associated with different antineoplastic drugs (busulfan, bleomycin), today there is more emphasis on the common pathological features. Therefore, instead of the expressions "busulfan lung" or "bleomycin lung", we suggest the use of the term "Zytostatika-Pneumopathie" (cytostatic drug induced lung disease).