Inselspital

Bern, Switzerland

Inselspital

Bern, Switzerland
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News Article | November 14, 2016
Site: www.eurekalert.org

NEW YORK (November 14, 2016) - A global outbreak of Mycobacterium chimaera, an invasive, slow-growing bacterium, is linked to heater-cooler devices (HCD) used in cardiac surgery, according to a study published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. This study adds interim guidance to recent field reports on the outbreak, providing precautionary recommendations to hospitals and health systems to reduce the risk of infections. "It is surprising that a global outbreak like this could go unnoticed for years. This dangerous infection has put many patients at risk all over the world," said Rami Sommerstein, MD, of Inselspital, Bern University Hospital in Switzerland, the lead author of the study. "Now that we know HCDs are the source, individual action from the different players (healthcare institutions, manufacturers, etc.) is needed to contain the ongoing patient risk. The most important action a hospital can take is to remove contaminated HCDs from the operating room and other critical areas. That is the only way to ensure that patients are protected from this infection moving forward." HCDs are stand-alone devices needed for heat exchange in heart-lung machines used in some 250,000 surgeries annually in the U.S., according to the Centers for Disease Control and Prevention. In response to an increasing number of infections, investigators looked into hospital water sources and found M. chimaera in HCD water circuits - specifically, in the LivaNova 3T HCD used in most hospitals around the world. They also found the bacteria in air samples during surgeries with LivaNova HCDs, suggesting transmission through air particles. To prevent future cases of invasive M. chimaera infections, the researchers made the following recommendations for hospitals and health systems, as well as public health authorities, based on their personal experience with the outbreak: M. chimaera is a non-tuberculous mycobacterium that was previously known to cause lung infections. Invasive M. chimaera in cardiac surgery patients is particularly difficult to treat because it requires surgery and prolonged antibiotic therapy. "While our understanding of the causes and the extent of the M. chimaera outbreak is growing, several aspects of patient management, device handling and risk mitigation still require clarification," said Sommerstein. Rami Sommerstein, Peter Schreiber, Daniel Diekema, Michael Edmond, Barbara Hasse, Jonas Marschall, Hugo Sax. "Mycobacterium chimaera Outbreak Associated with Heater-Cooler Devices - Piecing the Puzzle Together." Web (November 14, 2016). Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 13th out of 158 journals in its discipline in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters. SHEA is a professional society representing physicians and other healthcare professionals around the world with expertise and passion in healthcare epidemiology, infection prevention, and antimicrobial stewardship. SHEA's mission is to prevent and control healthcare-associated infections, improve the use of antibiotics in healthcare settings, and advance the field of healthcare epidemiology. SHEA improves patient care and healthcare worker safety in all healthcare settings through the critical contributions of healthcare epidemiology and improved antibiotic use. The society leads this specialty by promoting science and research, advocating for effective policies, providing high-quality education and training, and developing appropriate guidelines and guidance in practice. Visit SHEA online at http://www. , http://www. and @SHEA_Epi Cambridge University Press publishes over 350 peer-reviewed academic journals across a wide spread of subject areas, in print and online. Many of these journals are leading academic publications in their fields and together form one of the most valuable and comprehensive bodies of research available today. For further information about Cambridge Journals, visit journals.cambridge.org Cambridge University Press is part of the University of Cambridge. It furthers the University's mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. Its extensive peer-reviewed publishing lists comprise 45,000 titles covering academic research, professional development, over 350 research journals, school-level education, English language teaching and bible publishing. Playing a leading role in today's international market place, Cambridge University Press has more than 50 offices around the globe, and it distributes its products to nearly every country in the world. For further information about Cambridge University Press, visit cambridge.org


News Article | November 16, 2016
Site: www.sciencedaily.com

A global outbreak of Mycobacterium chimaera, an invasive, slow-growing bacterium, is linked to heater-cooler devices (HCD) used in cardiac surgery, according to a study published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. This study adds interim guidance to recent field reports on the outbreak, providing precautionary recommendations to hospitals and health systems to reduce the risk of infections. "It is surprising that a global outbreak like this could go unnoticed for years. This dangerous infection has put many patients at risk all over the world," said Rami Sommerstein, MD, of Inselspital, Bern University Hospital in Switzerland, the lead author of the study. "Now that we know HCDs are the source, individual action from the different players (healthcare institutions, manufacturers, etc.) is needed to contain the ongoing patient risk. The most important action a hospital can take is to remove contaminated HCDs from the operating room and other critical areas. That is the only way to ensure that patients are protected from this infection moving forward." HCDs are stand-alone devices needed for heat exchange in heart-lung machines used in some 250,000 surgeries annually in the U.S., according to the Centers for Disease Control and Prevention. In response to an increasing number of infections, investigators looked into hospital water sources and found M. chimaera in HCD water circuits -- specifically, in the LivaNova 3T HCD used in most hospitals around the world. They also found the bacteria in air samples during surgeries with LivaNova HCDs, suggesting transmission through air particles. To prevent future cases of invasive M. chimaera infections, the researchers made the following recommendations for hospitals and health systems, as well as public health authorities, based on their personal experience with the outbreak: M. chimaera is a non-tuberculous mycobacterium that was previously known to cause lung infections. Invasive M. chimaera in cardiac surgery patients is particularly difficult to treat because it requires surgery and prolonged antibiotic therapy. "While our understanding of the causes and the extent of the M. chimaera outbreak is growing, several aspects of patient management, device handling and risk mitigation still require clarification," said Sommerstein.


News Article | November 10, 2016
Site: www.marketwired.com

PHOENIX, AZ--(Marketwired - Nov 10, 2016) - Arizona Facial Plastics, PC, is proud to announce our grand opening. We are officially open for business at 4602 N. 16th St., Third Floor, Phoenix, AZ 85016. AFP is led by double board-certified facial plastic surgeon Dr. Farhan Taghizadeh, (known to his patients as Dr. T), who believes in providing the highest level of individually-tailored care to each client in a state-of-the-art, welcoming and relaxed environment. Dr. Taghizadeh is a nationally recognized expert in facial plastic surgery and has performed over 3,500 facelifts. His carefully selected team provides excellent patient care in a safe and trusting environment. "We are thrilled and grateful to be launching our practice in Phoenix," says Dr. Taghizadeh, "and our whole team is excited to provide clients with personalized service to help them look and feel their best. We pride ourselves on having the latest cosmetic technologies and procedures available to help us meet our goal of making you look and feel great." Dr. Taghizadeh has over a decade of experience in facial rejuvenation and extensive clinical knowledge. After completing his ENT training at the University of Rochester, Dr. Taghizadeh attended a prestigious AAFPRS facial plastic surgery fellowship in Switzerland where he received extensive cosmetic surgery training. His reputation for thoroughness as well as his in-depth understanding of the anatomical foundations of the head and neck make him uniquely qualified to give patients the highest quality surgical and non-invasive results. Arizona Facial Plastics, PC has a wide range of treatments designed to help you attain your optimal appearance. From minimally invasive solutions such as microneedling, which can help to reverse the appearance of blemished, dull, and aging skin for a more youthful appearance, to the HydraFacial™, which leaves skin hydrated and deeply cleansed, Arizona Facial Plastics strives to provide a tailored approach to your cosmetic needs. Offering a full line of injectables, platelet-rich plasma, and fat transfers, Arizona Facial Plastics can help you achieve the youthful look you seek. Dr. Taghizadeh also offers the highest quality amniotic products to promote fast healing for less downtime. In addition, Dr. Taghizadeh offers a full array of surgical cosmetic treatments. Dr. Taghizadeh uses his extensive experience of having performed 3,500 facelift and neck lift surgeries, and his ongoing technological research to provide all surgical patients with a natural and beautiful result. His state-of-the-art Canfield Imaging photography system gives potential rhinoplasty and revision rhinoplasty patients the best idea of how he can help them achieve a more aesthetically appealing nose. Dr. Taghizadeh always brings a personalized and friendly touch, and his patients know that they can take all the time they require and ask all the questions they want to make the best decision possible. He enjoys helping all of his patients achieve their goals with great outcomes, whether they are seeking to address issues of sun damage or are tired of looking older than they feel. To help all of our patients, regardless of their income level, Arizona Facial Plastics, PC, is pleased to offer convenient financing options, including Prosper® Healthcare Lending and CareCredit®. "I am tremendously excited to be able to offer the residents of Phoenix the very highest quality cosmetic services, and we are honored to be members of this wonderful community." Dr. Farhan Taghizadeh (www.arizonafacialplastics.com) completed his ENT training at the University of Rochester in 2004 and completed an AAFPRS Facial Plastic and Reconstructive Surgery Fellowship at the Inselspital in Bern, Switzerland. He is board-certified in otolaryngology and facial plastic and reconstructive surgery and is dedicated to making certain that each patient is treated with the utmost respect and concern throughout their relationship with Arizona Facial Plastics.


Peterli R.,Claraspital | Borbely Y.,Claraspital | Kern B.,Claraspital | Gass M.,Claraspital | And 6 more authors.
Annals of Surgery | Year: 2013

Objective: Laparoscopic sleeve gastrectomy (LSG) has been proposed as an effective alternative to the current standard procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB). Prospective data comparing both procedures are rare. Therefore, we performed a randomized clinical trial assessing the effectiveness and safety of these 2 operative techniques. METHODS: Two hundred seventeen patients were randomized at 4 bariatric centers in Switzerland. One hundred seven patients underwent LSG using a 35-F bougie with suturing of the stapler line, and 110 patients underwent LRYGB with a 150-cm antecolic alimentary and a 50-cm biliopancreatic limb. The mean body mass index of all patients was 44 ± 11.1 kg/m2, the mean age was 43 ± 5.3 years, and 72% were female. Results: The 2 groups were similar in terms of body mass index, age, sex, comorbidities, and eating behavior. The mean operative time was less for LSG than for LRYGB (87 ± 52.3 minutes vs 108 ± 42.3 minutes; P = 0.003). The conversion rate was 0.9% in both groups. Complications (<30 days) occurred more often in LRYGB than in LSG (17.2% vs 8.4%; P = 0.067). However, the difference in severe complications did not reach statistical significance (4.5% for LRYGB vs 1% for LSG; P = 0.21). Excessive body mass index loss 1 year after the operation was similar between the 2 groups (72.3% ± 22% for LSG and 76.6% ± 21% for LRYGB; P = 0.2). Except for gastroesophageal reflux disease, which showed a higher resolution rate after LRYGB, the comorbidities and quality of life were significantly improved after both procedures. CONCLUSIONS: LSG was associated with shorter operation time and a trend toward fewer complications than with LRYGB. Both procedures were almost equally efficient regarding weight loss, improvement of comorbidities, and quality of life 1 year after surgery. Long-term follow-up data are needed to confirm these facts. © 2013 by Lippincott Williams & Wilkins.


Tappeiner C.,Inselspital | Flueckiger F.,Institute of Virology and Immunoprophylaxis | Boehnke M.,Institute of Ophthalmology | Goldblum D.,University of Basel | Garweg J.G.,University of Bern
Journal of Cataract and Refractive Surgery | Year: 2012

Purpose: To assess the impact of topical anesthetic agents and ethanol on ocular surface wound healing using an ex vivo whole-globe porcine model. Setting: Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland. Design: Experimental study. Methods: Standardized corneoepithelial lesions (5.0 mm diameter, 40 μm depth) were created with excimer laser light in freshly enucleated porcine eyes. The globes (6 per group) were exposed to different concentrations of ethanol (2.0% to 99.0%), cocaine (2.0% to 10.0%), procaine hydrochloride (0.4%), tetracaine (0.5% to 1.0%), or lidocaine (2.0%), 3 drops/hour for 3 hours. Control solutions were physiologic saline, balanced salt solution, and tissue-culture medium. After 20 to 26 hours, wound-healing response was compared by measuring the diameter of each corneoepithelial lesion. Results: The mean diameter of corneoepithelial lesions exposed to physiologic saline decreased from 4.78 mm ± 0.19 (SD) to 4.44 ± 0.17 mm between 20 and 26 hours. After 24 hours, the mean lesion size, compared with physiological saline, was larger after cocaine 5.0% (5.20 ± 0.26 mm) and 10.0% (5.39 ± 0.12 mm), tetracaine 0.5% (5.59 ± 0.35 mm) and 1.0% (5.55 ± 0.27 mm), and procaine hydrochloride 0.4% (5.76 ± 0.12 mm), but not after lidocaine 2.0% (5.01 ± 0.17 mm). Balanced salt solution, tissue-culture medium, ethanol 2.0% to 99.0%, and cocaine 2.0% did not inhibit the wound-healing response. Conclusions: In an ex vivo whole-globe porcine model, lidocaine 2.0% and cocaine 2.0% were the least toxic anesthetic agents. At all concentrations, ethanol had no impact on wound healing. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2012 ASCRS and ESCRS.


Bittersohl B.,Heinrich Heine University Düsseldorf | Miese F.R.,Heinrich Heine University Düsseldorf | Hosalkar H.S.,Rady Childrens Hospital | Mamisch T.C.,Inselspital | And 3 more authors.
Investigative Radiology | Year: 2012

Objectives: The aim of this study was to identify the pattern of T2* values in acetabular and femoral head cartilage in morphologically normal and abnormal zones at 3 T. Materials and Methods: Twenty-nine patients (mean [SD] age, 30.8 [8.8] years) with symptomatic femoroacetabular impingement and suspected cartilage damage (study group) and 35 healthy, asymptomatic volunteers (mean [SD] age, 24.9 [2.1] years) with no obvious history of hip diseases or abnormalities (control group) were included. Magnetic resonance imaging was performed at 3 T using a 3-dimensional (3D) double-echo steady-state sequence for grading cartilage morphologically and a 3D multiecho data image combination sequence for T2* assessment. Statistical assessment included the Student t test to reveal differences between mean T2* values of the study group and the control group. One-way analysis of variance was used to identify any statistically significant differences between the T2* values in various grades (modified Outerbridge score system) of cartilage damage within the study group. Results: Significant differences were noted between the T2* values in the study group and the control group (P < 0.001). We also noted a significant drop in T2* in accordance with the morphologic damage in the study group (P < 0.001). The largest drop in T2* was found between morphologically normal-appearing cartilage (grade 0; T2*, 25.2 milliseconds) and grade I changes (T2*, 18.1 milliseconds) (P < 0.001). Conclusions: In combination with a 3-T system, T2* mapping offers unique advantages such as high image resolution and the ability of 3D biochemically sensitive cartilage evaluation in the hip joint without the need for contrast medium. Given these advantages, we believe that T2* mapping is another welcome addition to the rapidly evolving era of hip cartilage biochemical imaging. Further studies are necessary that involve a diagnostic histological analysis as gold standard for comparison. © 2012 by Lippincott Williams & Wilkins.


Radulovic K.,French Institute of Health and Medical Research | Radulovic K.,Institute Pasteur Of Lille | Niess J.H.,Inselspital
Journal of Immunology Research | Year: 2015

CD69 has been identified as an early activation marker of lymphocytes. However, recent work has indicated that CD69 plays an essential role for the regulation of inflammatory processes. Particularly, CD69 is highly expressed by lymphocytes at mucosal sites being constantly exposed to the intestinal microflora (one of the nature's most complex and most densely populated microbial habitats) and food antigens, while only a small number of circulating leukocytes express this molecule. In this review we will discuss the role of CD69 in mucosal tissue and consider CD69 as a potential target for the development of novel treatments of intestinal inflammation. © 2015 Katarina Radulovic and Jan Hendrik Niess.


Koenig K.F.,University of Basel | Groeschl I.,University of Basel | Pesickova S.S.,Charles University | Tesar V.,Charles University | And 2 more authors.
Cytokine | Year: 2012

Purpose: Determination of disease activity of lupus nephritis remains challenging. Since cytokines play a role as inflammatory mediators extending renal injury, measuring serum cytokine levels might help in the clinical assessment of patients with lupus nephritis. Therefore, the aim of this study was to determine the diagnostic value of a panel of serum cytokines in patients with active lupus nephritis. Methods: In this prospective controlled multicenter trial, sera of 12 patients with active lupus nephritis were collected in a clinical routine setting at the time of renal biopsy and 6. months afterwards. Fourteen patients with inactive systemic lupus erythematosus (SLE), and 14 healthy subjects were used as controls. Eleven cytokines (IL-4, IL-5, IL-6, IL-10, IL-12(p40), IL-12(p70), IL-18, TNF-α, TGF-β1, IFN-α2, IFN-γ) and two soluble receptors (IL-1ra and TNF-RII) were measured by cytokine multiplex assay. Results: In inactive SLE patients, serum levels of IL-10, IL-12(p40), IL-18 and TNF-RII were increased compared to healthy controls. Active lupus nephritis was found to be associated with further increase of these cytokine levels. Follow-up measurements in clinical remission of lupus nephritis showed downregulation of increased cytokines to levels found in inactive SLE. Most strikingly, TNF-RII serum level were elevated in all patients with active lupus nephritis (p< 0.001) and declined after clinical remission (p< 0.0005). Conclusion: The cytokine multiplex assay used in our study allowed a fast and stable analysis of a panel of serum cytokines in a clinical routine setting. In addition, serum cytokines, especially TNF-RII, might be excellent markers of active lupus nephritis. © 2012 Elsevier Ltd.


Ziebarth K.,Inselspital | Ziebarth K.,University of Bern | Leunig M.,Orthopaedic Surgery | Slongo T.,University of Bern | And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2013

Background: Traditionally arthrotomy has rarely been performed during surgery for slipped capital femoral epiphysis (SCFE). As a result, most pathophysiological information about the articular surfaces was derived clinically and radiographically. Novel insights regarding deformity-induced damage and epiphyseal perfusion became available with surgical hip dislocation. Questions/purposes: We (1) determined the influence of chronicity of prodromal symptoms and severity of SCFE deformity on severity of cartilage damage. (2) In surgically confirmed disconnected epiphyses, we determined the influence of injury and time to surgery on epiphyseal perfusion; and (3) the frequency of new bone at the posterior neck potentially reducing perfusion during epimetaphyseal reduction. Methods: We reviewed 116 patients with 119 SCFE and available records treated between 1996 and 2011. Acetabular cartilage damage was graded as +/++/+++ in 109 of the 119 hips. Epiphyseal perfusion was determined with laser-Doppler flowmetry at capsulotomy and after reduction. Information about bone at the posterior neck was retrieved from operative reports. Results: Ninety-seven of 109 hips (89%) had documented cartilage damage; severity was not associated with higher slip angle or chronicity; disconnected epiphyses had less damage. Temporary or definitive cessation of perfusion in disconnected epiphyses increased with time to surgery; posterior bone resection improved the perfusion. In one necrosis, the retinaculum was ruptured; two were in the group with the longest time interval. Posterior bone formation is frequent in disconnected epiphyses, even without prodromal periods. Conclusions: Addressing the cause of cartilage damage (cam impingement) should become an integral part of SCFE surgery. Early surgery for disconnected epiphyses appears to reduce the risk of necrosis. Slip reduction without resection of posterior bone apposition may jeopardize epiphyseal perfusion. Level of Evidence: Level IV, retrospective case series. See Guidelines for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.


Milligan T.A.,Brigham and Women's Hospital | Vulliemoz S.,HUG | Michaelides C.,Massachusetts General Hospital | Bertschi M.,Inselspital | Lee J.W.,Brigham and Women's Hospital
Neurocritical Care | Year: 2011

Background: Refractory status epilepticus (RSE) has a mortality of 16-39%; coma induction is advocated for its management, but no comparative study has been performed. We aimed to assess the effectiveness (RSE control, adverse events) of the first course of propofol versus barbiturates in the treatment of RSE. Methods: In this randomized, single blind, multi-center trial studying adults with RSE not due to cerebral anoxia, medications were titrated toward EEG burst-suppression for 36-48 h and then progressively weaned. The primary endpoint was the proportion of patients with RSE controlled after a first course of study medication; secondary endpoints included tolerability measures. Results: The trial was terminated after 3 years, with only 24 patients recruited of the 150 needed; 14 subjects received propofol, 9 barbiturates. The primary endpoint was reached in 43% in the propofol versus 22% in the barbiturates arm (P = 0.40). Mortality (43 vs. 34%; P = 1.00) and return to baseline clinical conditions at 3 months (36 vs. 44%; P = 1.00) were similar. While infections and arterial hypotension did not differ between groups, barbiturate use was associated with a significantly longer mechanical ventilation (P = 0.03). A non-fatal propofol infusion syndrome was detected in one patient, while one subject died of bowel ischemia after barbiturates. Discussion: Although undersampled, this trial shows significantly longer mechanical ventilation with barbiturates and the occurrence of severe treatment-related complications in both arms. We describe practical issues necessary for the success of future studies needed to improve the current unsatisfactory state of evidence. © 2010 Springer Science+Business Media, LLC.

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