Fribourg Hospital

Fribourg, Switzerland

Fribourg Hospital

Fribourg, Switzerland
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de Joliniere J.B.,Fribourg Hospital | Ayoubi J.M.,Foch Hospital | Lesec G.,Sipath Institute Of Cytologie Et Danatomie Pathologiques | Validire P.,Institute Mutualiste Montsouris | And 6 more authors.
Frontiers in Physiology | Year: 2012

Background: Recent findings strongly promoted the hypothesis that common pelvic gynecological diseases including endometriosis and ovarian neoplasia may develop de novo from ectopic endometrial-like glands and/or embryonic epithelial remnants. To verify the frequency, the anatomical localization and the phenotype of misplaced endometrial tissue along the fetal female reproductive tract, histological and immunohistochemical analyses of uteri, fallopian tubes, and uterosacral ligaments were performed. Methods: Reproductive organs were collected from seven female fetuses at autopsy, five of them from gestational ages between 18 and 26 weeks and two fetuses with gestational ages of 33 and 36 weeks deceased of placental anomalies. Serial sections from areas containing ectopic glands and embryonic duct residues were analyzed by histological and immunohistochemical procedures. Results: Numerous ectopic endometrial glands and stroma were detected in the myometrium in two fetuses with low levels of expression of estrogen receptor-alpha (ER-α) and progesterone receptors (PR). The embryonic ducts were localized in the uterine broad and ovarian ligaments and under the fallopian tube serosa in six fetuses. Low levels of steroid receptors expression were found in the embryonic residues, whereas the carcino-embryonic antigen (CEA) and the tumor marker Ca 125 were not detected. The embryonic residues stromal component strongly expressed the CD 10 and vimentin proteins. Conclusion: The anatomical and the immunohistochemical features of the ectopic organoid structures identified in fetal female reproductive tract suggest that endometriotic as well as neoplastic disease in adult women may develop on the basis of misplaced endometrial glands and/or embryonic cell remnants. © 2012 Bouquet de Jolinière, Ayoubi, Lesec, Validire, Goguin, Gianaroli, Dubuisson, Feki and Gogusev.


Finckh A.,University of Geneva | Moller B.,University of Bern | Dudler J.,Fribourg Hospital | Walker U.A.,University of Basel | And 2 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Background: Observational studies have suggested that patients with rheumatoid arthritis (RA) who experience inadequate response to anti-tumour necrosis factor (anti-TNF) agents respond more favourably to rituximab (RTX) than to an alternative anti-TNF agent. However, the relative effectiveness of these agents on long-term outcomes, particularly in radiographic damage, remains unclear. Objective: To compare the effectiveness of RTX against anti-TNF agents in preventing joint damage in patients with RA who have experienced inadequate response to at least one prior anti-TNF agent. Methods: This is a prospective cohort study within the Swiss registry of patients with RA who discontinued at least one anti-TNF agent and subsequently received either RTX or an alternative anti-TNF agent. The primary outcome, progression of radiographic joint erosions (Ratingen erosion score)over time, and the secondary outcome, functional disability (Health Assessment Questionnaire Disability Index), were analysed using regression models for longitudinal data and adjusted for potential confounders. Results: Of the 371 patients included, 104 received RTX and 267 received an alternative anti-TNF agent. During the 2.6-year median follow-up period, the rates of Ratingen erosion score progression were similar between patients taking RTX and patients taking an alternative anti-TNF agent (p=0.67). The evolution of the Health Assessment Questionnaire score was statistically significantly better in the RTX group (p=0.016), but the magnitude of the effect was probably not clinically relevant. Conclusion: This observational study suggests that RTX is as effective as an alternative anti-TNF agent in preventing erosions in patients with RA who have previously experienced inadequate response to anti-TNF agents.


Magnusson L.,Fribourg Hospital
Best Practice and Research: Clinical Anaesthesiology | Year: 2010

Spontaneous ventilation during general anaesthesia has been shown to favour atelectasis formation and decreased functional residual capacity. Therefore, general anaesthesia is commonly associated with endotracheal intubation and mechanical ventilation. Laryngeal lesions, residual curarisation, haemodynamics impairment, but most importantly, situation of cannot ventilate - cannot intubate may occur. Recently developed anaesthetic ventilators are able to detect spontaneous ventilation (triggering) and to give a pressure-limited flow cycled assisted breath (pressure support ventilation, PSV). Spontaneous ventilation assisted by PSV with laryngeal mask may avoid all the complications of endotracheal intubation and mechanical ventilation. Therefore, PSV should be a valid alternative for all patients having general anaesthesia with the exception of some contraindication. A close monitoring of tidal volume and minute ventilation is also needed. © 2010 Elsevier Ltd. All rights reserved.


Fournier S.,University of Lausanne | Taffe P.,Institute for Social and Preventive Medicine | Radovanovic D.,University of Zürich | Von Elm E.,Institute for Social and Preventive Medicine | And 9 more authors.
PLoS ONE | Year: 2015

Background Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results. The aim of this study was to analyze circadian variation of myocardial infarction size and in-hospital mortality in a large multicenter registry. Methods This retrospective, registry-based study was based on data from AMIS Plus, a large multicenter Swiss registry of patients who suffered myocardial infarction between 1999 and 2013. Peak creatine kinase (CK) was used as a proxy measure for myocardial infarction size. Associations between peak CK, in-hospital mortality, and the time of day at symptom onset were modelled using polynomial-harmonic regression methods. Results 6,223 STEMI patients were admitted to 82 acute-care hospitals in Switzerland and treated with primary angioplasty within six hours of symptom onset. Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001). The maximum average peak CK value (2,315 U/L) was for patients with symptom onset at 23:00, whereas the minimum average (2,017 U/L) was for onset at 11:00. The amplitude of variation was 298 U/L. In addition, no correlation was observed between ischemic time and circadian peak CK variation. Of the 6,223 patients, 223 (3.58%) died during index hospitalization. Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality. The risk of death from STEMI was highest for patients with symptom onset at 00:00 and lowest for those with onset at 12:00. Discussion As a part of this first large study of STEMI patients treated with primary angioplasty in Swiss hospitals, investigations confirmed a circadian pattern to both peak CK and in-hospital mortality which were independent of total ischemic time. Accordingly, this study proposes that symptom onset time be incorporated as a prognosis factor in patients with myocardial infarction. © 2015 Fournier et al.


Ryckx N.,University of Lausanne | Goy J.-J.,Fribourg Hospital | Stauffer J.-C.,Fribourg Hospital | Verdun F.R.,University of Lausanne
Radiation Protection Dosimetry | Year: 2016

As the number and complexity of fluoroscopically guided interventions increase, a serious effort has to be put on the optimisation of the X-ray dose delivered to the patient. In order to set up this optimisation process, the clinical practice for a given cardiology centre has to be analysed with relevant statistical power and compared with the data at local or national level. Data from 8 Swiss cardiology centres for 10 different vascular and heart rhythm procedures have been collected. The collected dose indicators were, when available, cumulated air kerma, cumulated dose-area product, fluoroscopy time and the number of images per procedure. Data analysis was performed using an in-house software solution in terms of the first, second and third quartiles. This kind of large-scale analysis could yield some onsets towards local practice optimisation based on anonymous dose indicator cross-comparison. Further effort should nevertheless be made in order to proceed towards an operator-based data analysis, thus allowing for an individual practice optimisation. © The Author 2016. Published by Oxford University Press. All rights reserved.


Tozzi P.,University of Lausanne | Michalis A.,Ecole Polytechnique Federale de Lausanne | Hayoz D.,Fribourg Hospital | Locca D.,University of Lausanne | Von Segesser L.K.,University of Lausanne
ASAIO Journal | Year: 2012

We describe a device made of artificial muscle for the treatment of end-stage heart failure as an alternative to current heart assist devices. The key component is a matrix of nitinol wires and aramidic fibers called Biometal muscle (BM). When heated electrically, it produces a motorless, smooth, and lifelike motion. The BM is connected to a carbon fiber scaffold, tightening the heart and providing simultaneous assistance to the left and right ventricles. A pacemaker-like microprocessor drives the contraction of the BM. We tested the device in a dedicated bench model of diseased heart. It generated a systolic pressure of 75 mm Hg and ejected a maximum of 330 ml/min, with an ejection fraction of 12%. The device required a power supply of 6 V, 250 mA. This could be the beginning of an era in which BMs integrate or replace the mechanical function of natural muscles. Copyright © 2012 by the American Society for Artificial Internal Organs.


Carron P.-N.,University of Lausanne | Taffe P.,University of Lausanne | Ribordy V.,Fribourg Hospital | Schoettker P.,University of Lausanne | And 2 more authors.
European Journal of Emergency Medicine | Year: 2011

OBJECTIVE: Accurate identification of major trauma patients in the prehospital setting positively affects survival and resource utilization. Triage algorithms using predictive criteria of injury severity have been identified in paramedic-based prehospital systems. Our rescue system is based on prehospital paramedics and emergency physicians. The aim of this study was to evaluate the accuracy of the prehospital triage performed by physicians and to identify the predictive factors leading to errors of triage. METHODS: Retrospective study of trauma patients triaged by physicians. Prehospital triage was analyzed using criteria defining major trauma victims (MTVs, Injury Severity Score >15, admission to ICU, need for immediate surgery and death within 48 h). Adequate triage was defined as MTVs oriented to the trauma centre or non-MTV (NMTV) oriented to regional hospitals. RESULTS: One thousand six hundred and eighti-five patients (blunt trauma 96%) were included (558 MTV and 1127 NMTV). Triage was adequate in 1455 patients (86.4%). Overtriage occurred in 171 cases (10.1%) and undertriage in 59 cases (3.5%). Sensitivity and specificity was 90 and 85%, respectively, whereas positive predictive value and negative predictive value were 75 and 94%, respectively. Using logistic regression analysis, significant (P<0.05) predictors of undertriage were head or thorax injuries (odds ratio >2.5). Predictors of overtriage were paediatric age group, pedestrian or 2 wheel-vehicle road traffic accidents (odds ratio >2.0). CONCLUSION: Physicians using clinical judgement provide effective prehospital triage of trauma patients. Only a few factors predicting errors in triage process were identified in this study. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


PubMed | University of Lausanne, University of Zürich, Institute for Social and Preventive Medicine and Fribourg Hospital
Type: Journal Article | Journal: PloS one | Year: 2015

Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results. The aim of this study was to analyze circadian variation of myocardial infarction size and in-hospital mortality in a large multicenter registry.This retrospective, registry-based study was based on data from AMIS Plus, a large multicenter Swiss registry of patients who suffered myocardial infarction between 1999 and 2013. Peak creatine kinase (CK) was used as a proxy measure for myocardial infarction size. Associations between peak CK, in-hospital mortality, and the time of day at symptom onset were modelled using polynomial-harmonic regression methods.6,223 STEMI patients were admitted to 82 acute-care hospitals in Switzerland and treated with primary angioplasty within six hours of symptom onset. Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001). The maximum average peak CK value (2,315 U/L) was for patients with symptom onset at 23:00, whereas the minimum average (2,017 U/L) was for onset at 11:00. The amplitude of variation was 298 U/L. In addition, no correlation was observed between ischemic time and circadian peak CK variation. Of the 6,223 patients, 223 (3.58%) died during index hospitalization. Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality. The risk of death from STEMI was highest for patients with symptom onset at 00:00 and lowest for those with onset at 12:00.As a part of this first large study of STEMI patients treated with primary angioplasty in Swiss hospitals, investigations confirmed a circadian pattern to both peak CK and in-hospital mortality which were independent of total ischemic time. Accordingly, this study proposes that symptom onset time be incorporated as a prognosis factor in patients with myocardial infarction.


PubMed | University of Lausanne, Fribourg Hospital and University of Fribourg
Type: Journal Article | Journal: Neuropsychologia | Year: 2016

From birth, the human visual system shows a remarkable sensitivity for perceiving biological motion. This visual ability relies on a distributed network of brain regions and can be preserved even after damage of high-level ventral visual areas. However, it remains unknown whether this critical biological skill can withstand the loss of vision following bilateral striate damage. To address this question, we tested the categorization of human and animal biological motion in BC, a rare case of cortical blindness after anoxia-induced bilateral striate damage. The severity of his impairment, encompassing various aspects of vision (i.e., color, shape, face, and object recognition) and causing blind-like behavior, contrasts with a residual ability to process motion. We presented BC with static or dynamic point-light displays (PLDs) of human or animal walkers. These stimuli were presented either individually, or in pairs in two alternative forced choice (2AFC) tasks. When confronted with individual PLDs, the patient was unable to categorize the stimuli, irrespective of whether they were static or dynamic. In the 2AFC task, BC exhibited appropriate eye movements towards diagnostic information, but performed at chance level with static PLDs, in stark contrast to his ability to efficiently categorize dynamic biological agents. This striking ability to categorize biological motion provided top-down information is important for at least two reasons. Firstly, it emphasizes the importance of assessing patients (visual) abilities across a range of task constraints, which can reveal potential residual abilities that may in turn represent a key feature for patient rehabilitation. Finally, our findings reinforce the view that the neural network processing biological motion can efficiently operate despite severely impaired low-level vision, positing our natural predisposition for processing dynamicity in biological agents as a robust feature of human vision.


PubMed | University of Lausanne and Fribourg Hospital
Type: Journal Article | Journal: Radiation protection dosimetry | Year: 2016

As the number and complexity of fluoroscopically guided interventions increase, a serious effort has to be put on the optimisation of the X-ray dose delivered to the patient. In order to set up this optimisation process, the clinical practice for a given cardiology centre has to be analysed with relevant statistical power and compared with the data at local or national level. Data from 8 Swiss cardiology centres for 10 different vascular and heart rhythm procedures have been collected. The collected dose indicators were, when available, cumulated air kerma, cumulated dose-area product, fluoroscopy time and the number of images per procedure. Data analysis was performed using an in-house software solution in terms of the first, second and third quartiles. This kind of large-scale analysis could yield some onsets towards local practice optimisation based on anonymous dose indicator cross-comparison. Further effort should nevertheless be made in order to proceed towards an operator-based data analysis, thus allowing for an individual practice optimisation.

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