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Simioni S.,University of Lausanne | Cavassini M.,Center hospitalier University Vaudois | Annoni J.-M.,University of Lausanne | Bourquin I.,University of Lausanne | And 3 more authors.
AIDS | Year: 2010

OBJECTIVE: To determine the prevalence of cognitive complaints and HIV-associated neurocognitive disorders (HANDs) in a cohort of aviremic HIV-positive patients. To evaluate the relevance of the HIV dementia scale to detect HANDs. DESIGN: Assessment of HANDs with neuropsychological tests. METHODS: Two hundred HIV-infected patients with undetectable HIV-1 RNA concentrations in the plasma, no history of major opportunistic infection of the central nervous system in the past 3 years, no current use of intravenous drugs, and no major depression answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of 50 complaining and 50 noncomplaining HIV-positive patients were assessed. RESULTS: Patients had undetectable HIV-1 RNA concentrations for a median time of 48 months (range 3.2-136.6). The prevalence of cognitive complaints was 27%. The prevalence of HANDs was 84% among patients with cognitive complaints (asymptomatic neurocognitive impairment 24%, mild neurocognitive disorders 52%, and HIV-associated dementia 8%) and 64% among noncomplainers (asymptomatic neurocognitive impairment 60%, mild neurocognitive disorders 4%, and HIV-associated dementia 0%; P < 0.001). A score of 14 points or less on the HIV dementia scale yielded a positive predictive value of HANDs of 92% in complainers and 82% in noncomplainers. CONCLUSION: The prevalence of HANDs is high even in long-standing aviremic HIV-positive patients. However, HANDs without functional repercussion in daily life (asymptomatic neurocognitive impairment) is the most frequent subtype observed. In this population, the HIV dementia scale with a cutoff of 14 points or less seems to provide a useful tool to screen for the presence of HANDs. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

De Bari B.,University of Lausanne | Alongi F.,Sacro Cuore Hospital | Lestrade L.,Hopitaux Universitaires Of Geneva Hug | Giammarile F.,University Claude Bernard Lyon 1
Critical Reviews in Oncology/Hematology | Year: 2014

Among PET radiotracers, FDG seems to be quite accepted as an accurate oncology diagnostic tool, frequently helpful also in the evaluation of treatment response and in radiation therapy treatment planning for several cancer sites. To the contrary, the reliability of Choline as a tracer for prostate cancer (PC) still remains an object of debate for clinicians, including radiation oncologists. This review focuses on the available data about the potential impact of Choline-PET in the daily clinical practice of radiation oncologists managing PC patients. In summary, routine Choline-PET is not indicated for initial local T staging, but it seems better than conventional imaging for nodal staging and for all patients with suspected metastases. In these settings, Choline-PET showed the potential to change patient management. A critical limit remains spatial resolution, limiting the accuracy and reliability for small lesions. After a PSA rise, the problem of the trigger PSA value remains crucial. Indeed, the overall detection rate of Choline-PET is significantly increased when the trigger PSA, or the doubling time, increases, but higher PSA levels are often a sign of metastatic spread, a contraindication for potentially curable local treatments such as radiation therapy. Even if several published data seem to be promising, the current role of PET in treatment planning in PC patients to be irradiated still remains under investigation. Based on available literature data, all these issues are addressed and discussed in this review. © 2014 Elsevier Ireland Ltd. Source

This article presents the results of a survey led by senior nurses at Geneva's University Hospital in 2007, in acute and long-term care. The aim was to identify obstacles and nursing resources available for patients with urinary incontinence (UI) in order to improve their care. METHOD; A questionnaire was sent to 3300 health care professionals: doctors, nurses, midwives and auxiliary nurses, with a response rate of 55%. Health care professionals have incomplete knowledge about UI however their mental representations of UI are not an obstacle to care. In their practice they use few assessment tools and specialized health care professional are rarely consulted. Current measures for improvement aim to make resources in UI more visible, develop practice guidelines and offer specific training. Source

Detterbeck F.C.,Yale University | Grodzki T.,Pomeranian Medical University | Gleeson F.,Churchill Hospital | Robert J.H.,Hopitaux Universitaires Of Geneva Hug
Journal of Thoracic Oncology | Year: 2010

The primary imaging modality for the detection of pulmonary metastases is computed tomography (CT). Ideally, a helical CT scan with 3- to 5-mm reconstruction thickness or a volumetric thin section scanning should be performed within 4 weeks of pulmonary metastasectomy. A period of observation to see whether further metastases develop does not seem to allow better patient selection. If positron emission tomography is available, it may identify the extrathoracic metastatic sites in 10 to 15% of patients. Despite helical CT scan, palpation identifies the metastases not detected by imaging in 20 to 25% of patients and remains the standard. No data define the optimal interval for follow-up surveillance imaging. Copyright © 2010 by the International Association for the Study of Lung Cancer. Source

Caflisch M.,Hopitaux Universitaires Of Geneva Hug
Therapeutische Umschau | Year: 2013

Adolescent medicine is situated "in between" and "on the borders of" different areas of medical specialisations: psychiatry, gynaecology, preventive medicine, paediatrics and internal medicine (and their respective subspecialties). The specificity of adolescent medicine is the evaluation of clinical situations with a particular consideration of the successive stages of the adolescent bio-psycho social development (puberty, identity construction, modifications of the relations to the peergroups and the family). A special interest goes also to preventive aspects, especially concerning experimental and risk behaviours. The medical approach to adolescents requires a particular attention to psychosocial aspects when confronted with somatic complaints and inversely a good somatic evaluation in front of adolescents suffering from complexes psychosocial situations. © 2013 Verlag Hans Huber, Hogrefe AG, Bern. Source

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