Cantonal Hospital Of St Gallen

Sankt Gallen, Switzerland

Cantonal Hospital Of St Gallen

Sankt Gallen, Switzerland
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Weber R.,University of Zürich | Ruppik M.,University of Zürich | Rickenbach M.,University of Lausanne | Spoerri A.,University of Bern | And 9 more authors.
HIV Medicine | Year: 2013

Background: Mortality among HIV-infected persons is decreasing, and causes of death are changing. Classification of deaths is hampered because of low autopsy rates, frequent deaths outside of hospitals, and shortcomings of International Statistical Classification of Diseases and Related Health Problems (ICD-10) coding. Methods: We studied mortality among Swiss HIV Cohort Study (SHCS) participants (1988-2010) and causes of death using the Coding Causes of Death in HIV (CoDe) protocol (2005-2009). Furthermore, we linked the SHCS data to the Swiss National Cohort (SNC) cause of death registry. Results: AIDS-related mortality peaked in 1992 [11.0/100 person-years (PY)] and decreased to 0.144/100 PY (2006); non-AIDS-related mortality ranged between 1.74 (1993) and 0.776/100 PY (2006); mortality of unknown cause ranged between 2.33 and 0.206/100 PY. From 2005 to 2009, 459 of 9053 participants (5.1%) died. Underlying causes of deaths were: non-AIDS malignancies [total, 85 (19%) of 446 deceased persons with known hepatitis C virus (HCV) status; HCV-negative persons, 59 (24%); HCV-coinfected persons, 26 (13%)]; AIDS [73 (16%); 50 (21%); 23 (11%)]; liver failure [67 (15%); 12 (5%); 55 (27%)]; non-AIDS infections [42 (9%); 13 (5%); 29 (14%)]; substance use [31 (7%); 9 (4%); 22 (11%)]; suicide [28 (6%); 17 (7%), 11 (6%)]; myocardial infarction [28 (6%); 24 (10%), 4 (2%)]. Characteristics of deceased persons differed in 2005 vs. 2009: median age (45 vs. 49 years, respectively); median CD4 count (257 vs. 321 cells/μL, respectively); the percentage of individuals who were antiretroviral therapy-naïve (13 vs. 5%, respectively); the percentage of deaths that were AIDS-related (23 vs. 9%, respectively); and the percentage of deaths from non-AIDS-related malignancies (13 vs. 24%, respectively). Concordance in the classification of deaths was 72% between CoDe and ICD-10 coding in the SHCS; and 60% between the SHCS and the SNC registry. Conclusions: Mortality in HIV-positive persons decreased to 1.33/100 PY in 2010. Hepatitis B or C virus coinfections increased the risk of death. Between 2005 and 2009, 84% of deaths were non-AIDS-related. Causes of deaths varied according to data source and coding system. © 2012 British HIV Association.

Biurrun Manresa J.A.,University of Aalborg | Neziri A.Y.,University of Bern | Neziri A.Y.,Cantonal Hospital Of St Gallen | Curatolo M.,University of Bern | And 2 more authors.
Pain | Year: 2013

Pain hypersensitivity has been consistently detected in chronic pain conditions, but the underlying mechanisms are difficult to investigate in humans and thus poorly understood. Patients with endometriosis pain display enlarged reflex receptive fields (RRF), providing a new perspective in the identification of possible mechanisms behind hypersensitivity states in humans. The primary hypothesis of this study was that RRF are enlarged in patients with musculoskeletal pain. Secondary study end points were subjective pain thresholds and nociceptive withdrawal reflex (NWR) thresholds after single and repeated (temporal summation) electrical stimulation. Forty chronic neck pain patients, 40 chronic low back pain patients, and 24 acute low back pain patients were tested. Electrical stimuli were applied to 10 sites on the sole of the foot to quantify the RRF, defined as the area of the foot from where a reflex was evoked. For the secondary end points, electrical stimuli were applied to the cutaneous innervation area of the sural nerve. All patient groups presented enlarged RRF areas compared to pain-free volunteers (P <.001). Moreover, they also displayed lower NWR and pain thresholds to single and repeated electrical stimulation (P <.001). These results demonstrate that musculoskeletal pain conditions are characterized by enlarged RRF, lowered NWR and pain thresholds, and facilitated temporal summation, most likely caused by widespread spinal hyperexcitability. This study contributes to a better understanding of the mechanisms underlying these pain conditions, and it supports the use of the RRF and NWR as objective biomarkers for pain hypersensitivity in clinical and experimental pain research. © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Neziri A.Y.,University of Bern | Neziri A.Y.,Cantonal Hospital of St Gallen | Bersinger N.A.,University of Bern | Andersen O.K.,University of Aalborg | And 5 more authors.
Regional Anesthesia and Pain Medicine | Year: 2014

Translational research has not yet elucidated whether alterations in central pain processes are related to peripheral inflammatory processes in chronic pain patients. We tested the hypothesis that the concentration of cytokines in the peritoneal fluid of endometriosis patients with chronic pain correlate with parameters of hyperexcitability of the nociceptive system. The concentrations of 15 peritoneal fluid cytokines were measured in 11 patients with chronic pelvic pain and a diagnosis of endometriosis. Six parameters assessing central pain processes were recorded. Positive correlations between concentration of some cytokines in the peritoneal fluid and amplification of central pain processing were found. The results suggest that inflammatory mechanisms may be important in the pathophysiology of altered central pain processes and that cytokines produced in the environment of endometriosis could act as mediators between the peripheral lesion and changes in central nociceptive processes. © 2014 American Society of Regional and Pain Medicine.

Aujesky D.,University of Bern | Roy P.-M.,University of Angers | Verschuren F.,Catholic University of Leuven | Righini M.,University of Geneva | And 15 more authors.
The Lancet | Year: 2011

Although practice guidelines recommend outpatient care for selected, haemodynamically stable patients with pulmonary embolism, most treatment is presently inpatient based. We aimed to assess non-inferiority of outpatient care compared with inpatient care. We undertook an open-label, randomised non-inferiority trial at 19 emergency departments in Switzerland, France, Belgium, and the USA. We randomly assigned patients with acute, symptomatic pulmonary embolism and a low risk of death (pulmonary embolism severity index risk classes I or II) with a computer-generated randomisation sequence (blocks of 2-4) in a 1:1 ratio to initial outpatient (ie, discharged from hospital ≤24 h after randomisation) or inpatient treatment with subcutaneous enoxaparin (≥5 days) followed by oral anticoagulation (≥90 days). The primary outcome was symptomatic, recurrent venous thromboembolism within 90 days; safety outcomes included major bleeding within 14 or 90 days and mortality within 90 days. We used a non-inferiority margin of 4 for a difference between inpatient and outpatient groups. We included all enrolled patients in the primary analysis, excluding those lost to follow-up. This trial is registered with, number NCT00425542. Between February, 2007, and June, 2010, we enrolled 344 eligible patients. In the primary analysis, one (0·6) of 171 outpatients developed recurrent venous thromboembolism within 90 days compared with none of 168 inpatients (95 upper confidence limit [UCL] 2·7; p=0·011). Only one (0·6) patient in each treatment group died within 90 days (95 UCL 2·1; p=0·005), and two (1·2) of 171 outpatients and no inpatients had major bleeding within 14 days (95 UCL 3·6; p=0·031). By 90 days, three (1·8) outpatients but no inpatients had developed major bleeding (95 UCL 4·5; p=0·086). Mean length of stay was 0·5 days (SD 1·0) for outpatients and 3·9 days (SD 3·1) for inpatients. In selected low-risk patients with pulmonary embolism, outpatient care can safely and effectively be used in place of inpatient care. Swiss National Science Foundation, Programme Hospitalier de Recherche Clinique, and the US National Heart, Lung, and Blood Institute. Sanofi-Aventis provided free drug supply in the participating European centres. © 2011 Elsevier Ltd.

Putzki N.,University of Duisburg - Essen | Putzki N.,Cantonal Hospital Of St Gallen | Katsarava Z.,University of Duisburg - Essen
Current Pain and Headache Reports | Year: 2010

Pain, including headache, is a frequent complaint of individuals with multiple sclerosis (MS). Prevalence of headache in patients with MS was reported to be higher than 50%, but it is uncertain if this is different than what is seen in the general population. Nonetheless, it is possible thatMS and headaches are comorbid. Case reports illustrated that isolated MS lesions (eg, in "strategic" regions like the midbrain) may cause severe headaches often resembling migraine. Furthermore, the role of MS disease-modifying agents needs to be taken into consideration. Mode of action and side effect profiles differ, and treatment per se may sometimes trigger headache in patients with MS. Thorough evaluation of headache in patients with MS is crucial to optimize patient management to help improve quality of life. © Springer Science+Business Media, LLC 2010.

Moller-Goede D.L.,University of Zürich | Moller-Goede D.L.,Cantonal Hospital of St Gallen | Brandle M.,Cantonal Hospital of St Gallen | Landau K.,University of Zürich | And 2 more authors.
European Journal of Endocrinology | Year: 2011

Objective: To assess frequency, symptoms and outcome of pituitary apoplexy (PA) among pituitary adenoma patients, to gain better insight into risk factors for bleeding into pituitary adenoma and to estimate the sequelae of PA by means of a matched control group. Method: By reviewing charts of 574 patients with pituitary adenoma, we analysed incidence, symptoms and outcome of PA and potential risk factors for developing PA by means of a control group (patients with pituitary adenoma without PA). Results: In total, 42 suffered from PA, all had macroadenomas; 30/217 male (14%) and 12/179 female (7%) macroadenoma patients, 32/194 patients with clinically non-functioning (16.5%) and 10/202 with clinically active (5.0%) macroadenoma were affected. Antithrombotic therapy predisposed patients to PA (P=0.026), diabetes mellitus and hypertension did not (P=1.00). Patients with PA and pituitary adenoma patients without PA had similar frequencies of hypopituitarism (45 vs 48%, P>0.05) and visual field defects (38 vs 55%, P>0.05), but ophthalmoplegia was significantly more common (76 vs 5%, P<0.001) in patients with PA. Nearly all patients were treated by surgery; most recovered from ophthalmoplegia, whereas visual function improved only moderately. Endocrine outcome was worse in patients with PA than in patients without PA. Conclusions: Male sex and characteristics of the adenoma itself (especially tumour size and tumour type) rather than patient's cardiovascular risk factors such as diabetes and hypertension seem to predispose to PA; antithrombotic therapy may also be important. © 2011 European Society of Endocrinology.

Surbeck W.,Cantonal Hospital Of St Gallen | Herbet G.,Montpellier University | Duffau H.,Montpellier University
Neuro-Oncology | Year: 2015

Background: Although neurological and neurocognitive outcomes have previously been studied after resection of diffuse low-grade glioma (DLGG), the impact of surgery on sexual life has not been investigated. Our aim was to assess whether DLGG surgery could have consequences on sexual experience. Methods: Anonymous standardized questionnaires concerning sexual functioning, including the Arizona Sexual Experiences Scale (ASEX) and a subjective statement, were completed by 32 patients who underwent surgery for DLGG. All patients returned to a normal social and professional life following resection, with neither neurological deficits nor depression. No radiotherapy was administered, and patients who received chemotherapy were without treatment for at least 1 year. Results: Seventeen patients (53%) reported a postoperative sexual change, with subjective deterioration in 15 (88%) and improvement in 2 (12%). Sexual dysfunction according to ASEX affected 9 of 15 women (60%) and 5 of 17 men (29%). Right-sided resections were associated with more difficulties in reaching orgasm than left-sided resections (P<.02). Men with temporal lobe resection displayed more reduction in sexual drive (P<.003) and sexual arousal (P,.004) than women, resulting in significant higher overall ASEX scores for temporal lobe resections in men (P =.01). Men remaining on antiepileptic drugs who underwent right-sided resection displayed higher overall ASEX scores than women (P =.031). Conclusions: This first evaluation of sexual life after surgery for DLGG suggests that sexual dysfunction is common in this population. Therefore, we suggest that sexual health should consistently be addressed during routine pre- and postoperative examination of patients with DLGG. © The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved.

Engeler D.S.,Cantonal Hospital Of St Gallen | Scandella E.,Cantonal Hospital Of St Gallen | Ludewig B.,Cantonal Hospital Of St Gallen | Schmid H.-P.,Cantonal Hospital Of St Gallen
Urologia Internationalis | Year: 2012

Introduction: Few published in vitro studies have shown antitumor drug action or possible synergistic effects of fluoroquinolones. To assess the potential role of combination therapy, cytotoxic effects of ciprofloxacin and epirubicin alone and in combination were determined. Material and Methods: Human urothelial cancer cell lines HT1197 and HT1376 were exposed in vitro for 1 h to different concentrations of epirubicin (0.02-2 mg/ml) and for 72 h to ciprofloxacin (0.004-0.8 mg/ml). Cytotoxicity was determined using the microculture tetrazolium assay and flow cytometry. Synergistic cytotoxic effects were determined by calculating combination indices. Results: Median effect concentrations of epirubicin for HT1376 and HT1197 cells were as low as 124 and 117 μg/ml, respectively. Ciprofloxacin-treated cells exhibited profound cytotoxic effects at concentrations of 50-100 μg/ml, which is far below the intravesical concentration reached by standard oral application. In addition, a pronounced synergistic effect was found when the two treatments were combined. Conclusions: This study provides evidence that ciprofloxacin and epirubicin exhibit synergistic cytotoxic effects in vitro. After confirmatory animal experiments, future clinical studies of adjuvant chemotherapy after transurethral bladder resection may include treatment arms with combinations of fluoroquinolones based on the observed synergistic effects to reduce both side effects and costs. © 2012 S. Karger AG, Basel.

Engel D.C.,Cantonal Hospital of St Gallen
Critical care (London, England) | Year: 2012

Standardization of data collection in severely injured trauma patients in order to find the best performance and practice has been an issue for more than 20 years. The incidence of trauma has decreased and outcomes have improved over the past decades. Trauma still remains an important public health problem, however, and is listed by the World Health Organization as a leading cause of death and disability. Ringdal and colleagues prove the feasibility on a basic level in their prospective, intercontinental study showing the results of the Utstein Trauma Template. In-depth analysis is currently only partially possible. The future of standardizing data collection in trauma looks bright. However, bridging and cross-linking is necessary to a great extent in the future.

Schultz C.,Cantonal Hospital Of St Gallen | Meier M.,Cantonal Hospital Of St Gallen | Schmid H.-P.,Cantonal Hospital Of St Gallen
Maturitas | Year: 2011

Three well-known and indisputable risk factors contribute to the development of prostate cancer, namely heredity, ethnic origin and increasing age. Geographic variations in incidence rates are considerable and it has, therefore, been suggested that environmental factors may also play a role. Migration studies clearly show that men with the same genetic background raised in different environments show a similar risk of developing the disease to those in their country of residency. Prostate cancer is a good candidate for studies on primary prevention thanks to specific features such as high prevalence, long latency, hormonal dependency, serum markers for monitoring (prostate-specific antigen) and histological precursor lesions (prostatic intraepithelial neoplasia). Nutritional factors that may influence the disease include total energy intake (as reflected by body mass index), dietary fat, cooked meat, micronutrients and vitamins (carotenoids, retinoids, vitamins C, D and E), fruit and vegetable intake, minerals (calcium, selenium), and phytoestrogens (isoflavonoids, flavonoids, lignans). Most published studies have been case-control analyses. The selenium and vitamin E cancer prevention trial (SELECT), however, was a population-based, prospective, randomized clinical trial that examined the effect of selenium and vitamin E alone or in combination on prostate cancer risk reduction. The trial was recently discontinued due to no evidence of benefit from either agent. Nevertheless, lifestyle changes can still be recommended for men at risk of developing clinical prostate cancer. © 2011 Elsevier Ireland Ltd.

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