Was durch einen Visusverlust ans Licht kommt

We report a case of a 36-year old patient who suffered from a unilateral painless loss of vision. Ophthalmological examination in the context of a highly reactive syphilis serology revealed an acute syphilitic posterior placoide chorioretinitis (ASPPC). Additional clinical findings were a mucosal lesion on the upper lip, consistent with a plaque opaline and an alopecia specifica as manifestation of secondary syphilis. Treatment consisted in 6x 4 Mio. IE Penicillin G for 14 days and 50 mg Prednison for five days to prevent a Jarisch Herxheimer reaction. The diagnostic measures, therapy and follow up of syphilis, focusing on ocular involvement, are described.

[Surgical therapy of gynecomastia]

Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient. A total of 162 patients suffering from gynecomastia stages I-III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction. The excised tissue should always be sent for histological examination to make sure no malignant cells were present.

Breast abscess due to Actinomyces europaeus

Actinomyces europaeus was first described in 1997 as a new species causing predominantly skin and soft-tissue infections. Mastitis due to A. europaeus is an unusual condition. This article reports a case of primary breast abscess caused by A. europaeus in a postmenopausal woman.

[Needle in the haystack - potentially dangerous syncope in childhood]

Syncope is a frequently observed symptom in pediatrics with teenagers being the age group most often affected. In contrast to older age, organic cardiac causes of syncope in child-hood are observed in a minority of only 2-5% of cases, in their majority pediatric syncopes thus are neurocardiogenic in origin. The rare organic cardiac causes that may manifest with syncope are all potentially dangerous entities such as cardiomyopathies, genetic primary electrical disease and some forms of structural heart disease, as well as some other rare diseases such as e.g. primary pulmonary hypertension. These diseases have to be actively looked for or excluded. Guidelines recommend patient evaluation including history, physical examination and ECG, which is sufficient to sort out suspect cases after a syncopal episode.

[Chronic pain - new therapeutic strategies]

Patient suffering from chronic pain need treatment in a multimodal setting. Enriched environment might be a new therapeutical approach.

[Consensus recommendations for the assessment of fitness to drive in cognitively impaired patients]

Memory Clinics provide evidence based diagnosis and treatment of dementia. Whenever a diagnosis of dementia is made, it is important to inform the patients about the possible impact of dementia on driving. Patients and their next of kin require competent advice whenever this difficult question is addressed and the mobility desire and the risks related to driving need to be carefully weight up. The time of diagnosis does not necessarily equate to the time when a person with dementia becomes an unsafe driver. The cause and severity of dementia, comorbidities and the current medication need to be carefully taken into account for this decision. On behalf of the association of the Swiss Memory Clinics, a group of experts has developed recommendations to assess fitness to drive in cognitively impaired older adults.

Ärztliche Haltung zur Komplementärmedizin in der Region Burgdorf

Hintergrund: Komplementärmedizinische Methoden sind in der Schweiz seit langem sehr beliebt. Gemäss den Schweizerischen Gesundheitsbefragungen 2002/2007 lassen sich mehr als 30% der Bevölkerung über 15 Jahren innerhalb eines Jahres komplementärmedizinisch behandeln. Auf Lebensfrist steigt diese Zahl auf 63.4%. Eine aktuelle Untersuchung der KIKOM zeigt, dass ca. 30% der befragten Grundversorgern in der ganzen Schweiz mehr als einmal pro Woche von Patienten nach Komplementärmedizin gefragt werden. Dieselbe Studie zeigt, dass ein Grossteil der befragten Grundversorger selber Komplementärmedizin anbieten oder Patienten für komplementärmedizinische Behandlungen überweisen. Zur Einstellung von Ärzten gegenüber Komplementärmedizin existieren viele Studien. Kaum untersucht ist bisher, ob und wie sich die Haltung von Spitalärzten und zuweisenden Ärzten nach Einrichtung eines Ambulatoriums/Konsiliartätigkeit mit Komplementärmedizin ändert. Fragestellung Wie ist die Haltung gegenüber Komplementärmedizin bei den Ärzten in der Region Burgdorf (Spital Burgdorf, zuweisende Ärzte) vor der Einrichtung einer Sprechstunden-/Konsiliartätigkeit von drei komplementärmedizinischen Methoden (Akupunktur/TCM, Anthroposophische Medizin, Klassische Homöopathie) am Spital Burgdorf und wie ist die Haltung nach einem Jahr und nach zwei Jahren? Methode: Mittels eines Fragebogens werden Meinung und Entschiedenheit dieser Aussage gegenüber Komplementärmedizin und ganzheitlichem Heilungsverständnis erfasst. Der Fragebogen steht Online zur Verfügung und wird zusätzlich allen Ärzten per Post zugeschickt. Die erste Befragung Ende 2010/Anfangs 2011 dient der Erhebung der Ausgangsdaten vor der Aufnahme der Sprechstundentätigkeit. In jährlichen Abständen wird die Umfrage wiederholt. Ergebnis: Von 170 verschickten Fragebogen wurden 6 nicht zugestellt. Lediglich 5 Teilnehmer haben den Fragebogen online ausgefüllt. 43 Fragebogen kamen spontan zurück. Nach telefonischem und schriftlichem Reminder konnten nochmals 26 Fragebogen eingeholt werden. Die Rücklaufquote beträgt damit 45% (74 von 164). Die weiteren Resultate sind in der Auswertung und werden im August zur Verfügung stehen.

Similarities and differences between physician and non-physician acupuncturists in using diagnostic methods - an explorative study

Purpose: Acupuncture is one of the complementary medicine therapies with the greatest demand in Switzerland and many other countries in the West and in Asia. Over the past decades, the pool of scientific literature in acupuncture has markedly increased. The diagnostic methods upon which acupuncture treatment is based, have only been addressed sporadically in scientific journals. The goal of this study is to assess the use of different diagnostic methods in the acupuncture practices and to investigate similarities and differences in using these diagnostic methods between physician and non-physician acupuncturists. Methods: 44 physician acupuncturists with certificates of competence in acupuncture – traditional chinese medicine (TCM) from ASA (Assoziation Schweizer Ärztegesellschaften für Akupunktur und Chinesische Medizin: the Association of Swiss Medical Societies for Acupuncture and Chinese Medicine) and 33 non-physician acupuncturists listed in the EMR (Erfahrungsmedizinisches Register: a national register, which assigns a quality label for CAM therapists in complementary and alternative medicine) in the cantons Basel-Stadt and Basel-Land were asked to fill out a questionnaire on diagnostic methods. The responder rate was 46.8% (69.7% non-physician acupuncturists and 29, 5% physician acupuncturists). Results: The results show that both physician and non-physician acupuncturists take patients’ medical history (94%), use pulse diagnosis (89%), tongue diagnosis (83%) and palpation of body and ear acupuncture points (81%) as diagnostic methods to guide their acupuncture treatments. Between the two groups, there were significant differences in the diagnostic tools being used. Physician acupuncturists do examine their patients significantly more often with western medical methods (p<.05) than this is the case for nonphysician acupuncturists. Non-physician acupuncturists use pulse diagnosis more often than physicians (p<.05). A highly significant difference was observed in the length of time spent with collecting patients’ medical history, where nonphysician acupuncturists clearly spent more time (p<.001). Conclusion: Depending on the educational background of the acupuncturist, different diagnostic methods are used for making the diagnosis. Especially the more time consuming methods like a comprehensive anamnesis and pulse diagnosis are more frequently employed by non-physician practitioners. Further studies will clarify if these results are valid for Switzerland in general, and to what extent the differing use of diagnostic methods has an impact on the diagnosis itself and on the resulting treatment methods, as well as on the treatment success and the patients’ satisfaction.