Biomedical subjects

E Graf-Deuel

Publications and source records attributed to E Graf-Deuel.

3 recordsLinked to original sources

PubMed1999

[Tuberculin testing of hospital personnel: large investment with little impact].

Guidelines for the control and prevention of nosocomial tuberculosis include recommendations for surveillance of hospital employees with tuberculin skin tests (TST). We analysed a 2 1/2-year period of tuberculin skin testing at Kantonsspital St. Gallen, an 850-bed hospital in eastern Switzerland with 2000 employees and 21,000 admissions yearly. Tuberculosis cases among employees are reported for a 10-year period. TST were performed on engagement, if no recent positive result was available. A new TST was read in 717 (58%) of 1241 persons starting employment during the study period. In 261 workers in contact with 23 sputum smear positive tuberculosis patients, 180 (69%) follow-up TST were performed. Of a total of 37 increases in TST, 20 (54%) were retrospectively attributed to other causes than a recent infection with M. tuberculosis (vaccination with BCG, booster phenomenon, doubts concerning the previous test result). Of the remaining 17 TST converters, 5 finally completed a full course of preventive chemotherapy. With a total workload of 547 hours for this result, half a year's working hours were necessary to prevent one case of active tuberculosis. Over a 10-year period, 4 out of 9 active tuberculosis cases in employees were likely to be nosocomially acquired, but none was diagnosed thanks to TST surveillance. We conclude that surveillance with TST is time consuming, but has little impact on the tuberculosis situation in hospital employees. Alternative strategies to this unsatisfactory system are discussed.

Adult↗

PubMed1994

Simultaneous bilateral spontaneous pneumothorax.

We describe 12 patients with simultaneous bilateral spontaneous pneumothorax (SBSP). They represent 4 percent of patients with spontaneous pneumothorax seen at our hospital from 1971 to 1990. Five of the 12 had no underlying lung disease. In the seven remaining patients, SBSP was secondary to histiocytosis X, lymphangioleiomyomatosis, osteogenic sarcoma with pleural and pulmonary metastases, Hodgkin's disease, mesothelioma, cystic fibrosis, or miliary tuberculosis. Nineteen of the 56 patients with SBSP (34 percent) described in the literature (this series included) had pulmonary disease related to disorders of cells of mesenchymal origin. Emphysema and bullous lung disease were not associated with SBSP. Long-term prognosis was a function of pulmonary status. Four of the patients described herein died during the period reviewed. All suffered from severe underlying disease. In no case was SBSP the main cause of death. With timely treatment, the short-term prognosis is benign even for patients with underlying lung disease. Surgical pleurectomy should be attempted early, especially in SBSP secondary to underlying lung disease.

Adolescent↗

PubMed1980

[Value of renal biopsy in deteriorating graft function following renal allotransplantation].

The value of renal transplant biopsy in determining the cause of deteriorating graft function was evaluated by comparing morphologic diagnoses with clinical findings and ultimate course in a series of 104 biopsies. Transplant biopsy was a valuable tool in diagnosing acute and chronic transplant rejection. It was superior to clinical parameters, mainly in differentiating vascular transplant rejection (which is usually associated with poor prognosis) from cellular rejection (associated with a much better prognosis). Biopsy was less effective in detecting deteriorating function due to ureteral stenosis. Transplant biopsy was essential in determining the case of proteinuria, thanks to its ability to differentiate the various types of glomerular transplant lesions.

Biopsy↗