[Spontaneous intraperitoneal hemorrhage: etiology]. / Hémorragies intrapéritonéales spontanées: étiologies.

Spontaneous intraperitoneal hemorrhage is a rare and sometime fatal condition. The clinical presentation may range from a non-specific abdominal pain to an acute abdomen with hemodynamic instability. Often, a preoperative diagnosis cannot be obtained. Immediate surgical exploration remains the treatment of choice. However, pre or postoperative diagnosis can sometime be confirmed and treated with interventional radiology. In rare cases, the site of bleeding remains unknown despite intraoperative exploration and radiographic studies.

Technical means for securing health information.

Securing health information is an application domain which can learn more from other environments like airlines and banking than from military formalism or academic freedom. The techniques of the 80s using clear separation between public and private areas have to be upgraded. Propositions are made. Costs are evaluated.

The doctor's view on education and training aspects of secure communication.

Using two examples of installed applications that are widely spread in a large teaching hospital, the awareness of secure communication is highlighted. Teaching to the rotating medical staff is organised on a regular basis. The physicians learn the responsibility they accept when entering the hospital information system (HIS). In a distributed environment, the confidentiality aspects change with the technology when the users perform with on-line helps and graphical interfaces.

The technical conditions for an open architecture.

The development of Open Systems Architecture and the extensive networked interconnection of Health and Hospital Information Systems (HIS) offer great opportunities for improved care, but simultaneously these facilities pose a great danger to the overall security of the information held. The Geneva University Hospital which has built up it centralized informatics system over the last twenty years must now bring about the conditions for a migration towards open system, for although during the last ten years there have been declarations of intent, this architecture is still a long way from final implementation. Like others, the DIOGENE system (the Geneva HIS) has had to face difficult choices especially due to its own successful situation at the end of the eighties. This paper gives a brief explanation of the technical conditions needed in order to fully migrate towards an open system. The first choices towards obtaining optimum communication standards, operating systems and database management systems were the easiest. The real difficulties occurred when deciding on the choice for management tools in this open environment.

[Holmium:YAG laser in surgical practice in a multidisciplinary hospital center]. / Laser Holmium:YAG en pratique chirurgicale dans un centre hospitalier pluridisciplinaire.

The Holmium:YAG laser has been in use at the regional hospital of Montreux, Switzerland. A balance has been drawn at the end of 9 months. 68 surgical operations have been performed; 23 in abdominal surgery, mainly through laparoscopy, and 45 in orthopaedics using scopic viewing. The Holmium:YAG laser is a modern and up-to-date system. It is well adapted to endoscopic surgery owing to its features, its wide scope and safe use. Its price is rather high if used for laparoscopic cholecystectomy only; but the purchase thereof is proving to be a profitable asset for a multiservice surgical team.

A double-blind comparison of nimesulide and mefenamic acid in the treatment of acute upper respiratory tract infections in children.

The efficacy and safety of nimesulide suspension were evaluated in comparison with mefenamic acid in a double-blind multicentre study that recruited 100 children with acute respiratory tract infections. On entry, each child was randomly allocated to receive either nimesulide 5 mg/kg/day or mefenamic acid 5 mg/kg divided into 2 or 3 daily doses as an oral suspension, for a period of 3 to 10 days. Body temperature returned to normal on the third day for most of the nimesulide-treated patients, but only on the fifth day for the mefenamic acid group. There was a significant difference (p < 0.01) between the antipyretic activity of nimesulide and that of mefenamic acid. Furthermore, treatment with nimesulide was associated with clinically significant improvement in all inflammatory signs and symptoms observed (rhinorrhoea, nasal obstruction, pharyngeal redness, swelling of lymph nodes and cough). Adverse effects considered possibly related to treatment were recorded for 3 patients treated with nimesulide and 1 with mefenamic acid.