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Sankt Gallen, Switzerland

Strub B.,Clinic for Hand | Sonderegger J.,Clinic for Hand | Campe A.V.,Clinic for Hand | Grunert J.,Clinic for Hand | Osterwalder J.J.,St. Gallen Cantonal Hospital
Journal of Hand Surgery: European Volume

Axillary block for brachial plexus anaesthesia is a popular anaesthetic technique for hand surgery with different approaches. We investigated the efficacy of the blind and ultrasound-guided approaches administered by a hand surgeon. A total of 141 patients were prospectively randomized to Group A without and Group B with ultrasound guidance. The principal variables evaluated were number of failures, duration of surgery, time to onset of anaesthesia, volume of anaesthetic injected, and complications. The success rate and the mean time to onset of anaesthesia were significantly better under ultrasound guidance. The duration of surgery and the rate of complications did not differ. Ultrasound-guided plexus anaesthesia is markedly more effective than the blind technique when performed by a hand surgeon. © The Author(s) 2011. Source

Audige A.,University of Zurich | Schlaepfer E.,University of Zurich | Von Wyl V.,University of Zurich | Miller R.C.,University of Zurich | And 3 more authors.
AIDS Research and Human Retroviruses

Each cell in HIV-associated primary central nervous system lymphoma (PCNSL) harbors latent EBV. Notably, the triggering of TLR9, a key event in HIV pathogenesis, also promotes EBV latency and transformation. We hypothesized that because only a minority of HIV-infected patients develops PCNSL, their B cells exhibit aberrant signaling responses to TLR9 triggering. We found higher levels of IL-6, CD80, and CD86 expression at baseline in B cells of those patients than in B cells of matched controls, whereas TNF-α expression was lower. Notably, on TLR9 triggering with CpG 2006, CD80 and TNF-α were up-regulated to a lesser extent in B cells of the former than in those of matched controls. The reduced up-regulation of CD80 might be explained by its higher baseline expression resulting in a more blunted response rather than a specific deficit of the signaling response to TLR9 triggering. However, this cannot explain the blunted TNF-α response, which warrants further investigation. Finally, since increased IL-6 expression is linked to EBV-associated Hodgkin's lymphoma, the enhanced baseline expression of IL-6 might be important in the pathogenesis of PCNSL in HIV-infected patients. Copyright 2010, Mary Ann Liebert, Inc. Source

Zecha H.,St. Gallen Cantonal Hospital | Schmid H.-P.,St. Gallen Cantonal Hospital | Tschopp A.,University of Zurich | Sulser T.,University of Zurich | And 2 more authors.
Scandinavian Journal of Urology and Nephrology

Objective. The incidence of urogenital tumours is constantly increasing as a result of over-proportional ageing of the population in industrialized nations. Follow-up of non-muscle-invasive bladder cancer (NMIBC) primarily relies on the detection of either relapse or progression and does not include screening for second malignancies. This study investigated the incidence of independent non-urothelial second malignancies and associated risk factors in patients with NMIBC. Material and methods. The charts of 380 consecutive patients (297 men and 83 women) with newly diagnosed NMIBC over a 16-year period at a Swiss hospital were analysed retrospectively. Age, stage of bladder tumour, smoking status, and occurrence of second and third malignancies were registered. Observed incidences of independent non-urothelial malignancies were compared with age- and gender-specific rates based on data from the National Institute for Cancer Epidemiology and Registration by calculating standardized incidence ratios (SIRs). Results. Mean age at first NMIBC diagnosis was 69.9 years. Histological stage of the NMIBC was pTa in 241 patients (63.4%), pT1 in 102 (26.8%)and pTis in 37 (9.7%). During follow-up, 62 independent non-urothelial second or third malignancies were observed in 48 men (16.2%) and 10 women (12.0%). In male patients, prostate and lung cancer (SIR 4.3 and 5.7, respectively) were more frequent than expected in the general population, as were lung and uterine cancer in women. Conclusions. Follow-up in patients with NMIBC should pay special attention to independent non-urothelial malignancies. Investigations for non-urological malignant disease, especially for lung cancer, should form part of the standard follow-up in NMIBC patients. © 2011 Informa Healthcare. Source

Abt D.,St. Gallen Cantonal Hospital | Mordasini L.,St. Gallen Cantonal Hospital | Warzinek E.,St. Gallen Cantonal Hospital | Schmid H.-P.,St. Gallen Cantonal Hospital | And 3 more authors.
Korean Journal of Urology

Purpose: Temporary drainage of the upper urinary tract by use of internal ureteral stents is a common procedure that is often associated with a variety of symptoms. The role of intravesical stent position in associated morbidity is controversial. Materials and Methods: The German version of the ureteral stent symptom questionnaire (USSQ) was completed by 73 patients with an indwelling ureteral stent the day before stent removal. Intravesical stent position was classified into 3 categories by xray before stent removal. The influence of intravesical stent position on USSQ score was analyzed, including subscores and single items. Results: Intravesical stent position showed no significant influence on associated morbidity. The median USSQ total score in all patients was 77.5 (range, 30–147). Patients with ipsilateral stents (69.0; range, 30–122) tended to have lower total scores than did those with tangential (86.5; range, 30–122) or contralateral (77.0; range, 31–147) stents, but the differences were not statistically significant (p=0.35). The USSQ subscores for urinary symptoms (p=0.80), body pain (p=0.80), general health (p=0.16), work performance (p=0.07), additional problems (p=0.81), and all of the USSQ single items of interest in the context of stent length also did not differ significantly between the three groups. Conclusions: Intravesical stent position did not significantly influence associated morbidity in our study. An appropriate stent length should be chosen to avoid dislocation. However, complex calculations of optimum stent length, time-consuming manipulations, and costly stock holding of various stent sizes to obtain the perfect stent position do not seem worthwhile. © The Korean Urological Association, 2015. Source

Abt D.,St. Gallen Cantonal Hospital | Warzinek E.,St. Gallen Cantonal Hospital | Schmid H.-P.,St. Gallen Cantonal Hospital | Haile S.R.,Clinical Trials Unit | Engeler D.S.,St. Gallen Cantonal Hospital
International Journal of Urology

Objectives: To investigate the influence of patient education on symptoms and problems caused by ureteral stents. Methods: The German version of the Ureteral Stent Symptom Questionnaire was completed by 74 patients with unilateral inserted indwelling stents. Additionally, six self-developed questions regarding type and quality of patient education on pain, urinary symptoms, hematuria, activities permitted, stent function and overall patient education were answered. Correlations between questionnaires, subscores and single items, and the influence on economic aspects were analyzed. Results: Adjusting for age, sex, intravesical stent length, stent indwelling time, use of analgesics and an alpha-blocker, the correlation between the Ureteral Stent Symptom Questionnaire and self-developed questions was -0.40 (95% CI -0.58, -0.19, P<0.001). The following subscores and items showed a statistically significant correlation with quality of patient education after correction for multiple testing: Ureteral Stent Symptom Questionnaire total score, urinary symptoms subscore, U6, U10, G3, G4 and GQ. No relevant influence of patient education on economic aspects was found. Conclusion: High-quality patient education on ureteral stent-related symptoms is highly advisable, as it has the potential to reduce these symptoms. However, the influence of information on the incidence and extent of potential problems seems to be limited. A much better approach would be to develop better designed devices and more convenient stent-free procedures. © 2015 The Japanese Urological Association. Source

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