Clinical chemistry variables in normal elderly and healthy ambulatory populations: comparison with reference values.

Laboratory values of the most commonly assayed clinical chemistry variables were determined in selected elderly and healthy ambulatory populations. The upper and lower limits (2.5 and 97.5 fractiles) were compared with the adult reference values in use in university hospitals of Switzerland. The results suggest that conventional adult reference values can be used for most variables in the elderly and that these values are also useful in an ambulatory population.

[Screening for problem alcohol drinking in the Swiss population: comparison between an ISPA-developed instrument and the CAGE questionnaire. The Swiss Institute for the Prevention of Alcoholism]. / Dépistage de consommations problématiques d'alcool dans la population suisse: comparaison entre un instrument développé par l'ISPA et le questionnaire CAGE.

In 1987, the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA) developed a set of questions on alcohol-related problems in the general population. The aim of this article is to study the results of the questionnaire used as a screening instrument to detect problem drinking in the Swiss population, and to compare it with the CAGE test. The sample consisted of 953 people aged 20 or over. Among the drinkers (89% of the sample), 91 males (21.7%) and 34 females (8.7%) had a positive SIPA test and 53 males (12.7%) and 17 females (4.3%) a positive CAGE test. The SIPA test was more sensitive than the CAGE in detecting persons who drink regularly and quite heavily but without binge drinking. The item "Eye-opener" of the CAGE is too blunt for application to the Swiss general population and could with advantage be removed from the questionnaire. Females tend to deny alcohol problems much more than males. Binge drinking increases the risk of a positive test (SIPA: OR: 1.9; i.c. 95%: 1.2-3.0; CAGE: OR: 3.3; i.c. 95%: 1.8-6.0). In short, the SIPA test is more suitable in estimating the number of problem drinkers in the Swiss population than the CAGE, which was initially developed for the American medical population. Furthermore, the results suggest the necessity of using a different cut-off for each gender.

Nosocomial infections and pseudoinfections from contaminated bronchoscopes: two-year follow up using molecular markers.

During a 6-month period, two genetically distinct clones were isolated from 65% of patients with Pseudomonas aeruginosa isolated from bronchial specimens obtained during or after bronchoscopy. This epidemic was due to contamination of bronchoscopes by washing machines. After reintroduction of manual disinfection of endoscopes, a significant decrease in the incidence of the epidemic clones was observed, but the incidence of nonepidemic P aeruginosa did not change. The distinction between sporadic and epidemic cases was possible only with the use of a molecular typing method (ribotyping).

[Prospective surveillance of nosocomial infections in a traumatology and orthopedics service]. / Surveillance prospective des infections nosocomiales dans un service de traumatologie et orthopédie.

From May 1989 to February 1990, 1164 patients were followed in the Service of Orthopaedic Surgery and Traumatology at the CHUV, for the development of nosocomial infections (N.I.), in particular postoperative wound infections. Among them, 439 patients were treated conservatively and 725 underwent 833 operations. The global incidence of N.I. was 7.7/100 admissions. Urinary tract infections represented 57% of all N.I., postoperative wound infections represented 21% (with 12% superficial and 9% deep infections), pneumonias represented 20% (5 deaths), bacteriemias represented 2% (1 death) of the cases. The rate of infections was 1.1% for clean surgical interventions (n = 549), 0% for clean-contaminated operations (n = 87), 7.5% for contaminated operations (n = 40), 22.8% for dirty operations and 1.6% for unclassified operations (n = 122). Among the 19 postoperative wound infections, 6 were diagnosed after the patients were discharged. In conclusion, postoperative wound infections constituted only 20% of all N.I. observed in the Service of Orthopaedic Surgery and Traumatology and the rates of infection according to the types of interventions were low. On the other hand, 80% of the N.I. were observed at sites other then the wounds and were associated with a 0.5% mortality rate.

Plasma carnitines: reference values in an ambulatory population.

Carnitine was determined radioenzymatically in the plasma of 415 hospital employees involved in a screening programme for prevention of major cardiovascular risks. A reference population (N = 340) was extracted after excluding subjects with hypertension, diabetes mellitus or treatment for hypercholesterolaemia. This population showed a Gaussian distribution for total and free carnitine concentrations both in females and males but not for acyl carnitine or the acyl/free ratio. Females had lower total and free carnitine concentrations but a higher ratio of acyl/free carnitine than males. These differences were not detectable in older subjects (35 years for the acyl/free ratio, 45 years for total and free carnitine concentrations). Females with a body mass index > 28 had a lower acyl/free ratio than their respective controls. The differences in carnitine concentrations indicate that sex and age should be matched in patients or experimental groups and controls in studies involving carnitine plasma concentrations.

[Screening for cardiovascular disease risk factors among employees of a hospital]. / Dépistage des facteurs de risque des maladies cardiovasculaires chez les employés d'un hôpital.

A health promotion and screening program for the detection of the major risk factors for ischemic heart disease was carried out in 1990 among the employees (n = 4,521; 70% female) of the Centre Hospitalier Universitaire Vaudois (CHUV). The prevalence of risk factors among the 1,425 employees (73% female) who took part in the study (participation rate: males 29%, females 33%) was compared with the prevalence of risk factors within three other populations: 1) new CHUV employees, who are systematically screened (n = 424: 71% female); 2) a representative sample of the general population; and 3) a group of employees from 44 companies located in the same region. Smoking was the most common of the three main risk factors; its prevalence was lowest among CHUV employees and highest among employees of the 44 firms. The prevalence of hypercholesterolemia and high blood pressure was variable among the different populations. These variations could partly be due to differences in methodologies and measurement conditions, but could not totally be explained in this way.

[Screening for and treatment of risk factors of cardiovascular diseases: need for a strategy?]. / Dépistage et traitement des facteurs de risque des maladies cardio-vasculaires: nécessité d'une stratégie?

A major reduction in ischemic cardiovascular diseases depends on prevention of risk factors (RF) for atherosclerosis. To assess how screening and treatment of these RF were undertaken in an outpatient setting, we reviewed 300 charts of Swiss men (age 17 to 86, mean 50) who were compliant with medical follow-up. We noticed that the six RF taken into account were insufficiently investigated among young people. Furthermore, hypercholesterolemia was largely underinvestigated, even in the presence of other RF for atherosclerosis. These findings indicate that both the importance of early detection and the clinical significance of dyslipidemia are underestimated by physicians. This situation would be improved by a health policy adapted to Swiss medical practice which defined rules of screening and treatment of RF for atherosclerosis.

Effect of malotilate on chronic liver injury induced by carbon tetrachloride in the rat.

The effect of malotilate, a new drug proposed for the treatment of chronic liver diseases, was studied in carbon tetrachloride (CCl4)-induced chronic liver injury in the rat. Treatment with CCl4 (0.5 ml/kg twice per week, intraperitoneally for 6 or 9 weeks) led to marked necrosis, steatosis and fibrosis, as shown by both biochemical and histological examinations, and a significant decrease of the bromosulfophtaleine (BSP) clearance test. Malotilate (50 mg/kg p.o., 5 days per week given simultaneously with CCl4 for 6 weeks), suppressed the increase of plasma aminotransferase activity and decreased significantly the accumulation of lipid and collagen in the liver; histology confirmed this protective effect of malotilate. The BSP clearance test returned to normal values and the rise in hepatic collagen synthesis activity in the malotilate-treated and intoxicated rats was reduced as compared with intoxicated control rats. The same effect was found when malotilate (100 mg/kg, p.o., 5 days per week), was given for 3 weeks to rats already intoxicated during the 6 previous weeks. Malotilate was able to prevent the increase of hepatic alterations that appeared during the last 3 weeks of CCl4 intoxication. These results show clearly that malotilate can markedly reduce the hepatic disorders induced by a chronic CCl4 intoxication in the rat.