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Sankt Gallen, Switzerland

Postinfectious glomerulonephritis is an immune-mediated disease occurring as a result of the host response to an extrarenal infection. The classical form of poststreptococcal disease is decreasing worldwide but remains a significant health care problem in developing countries, especially in children. In industrialised countries postinfectious glomerulonephritis is now primarily due to non-streptococcal disease. In elderly patients with risk factors such as diabetes mellitus, alcohol-dependency or neoplasia and in intravenous drug users postinfectious glomerulonephritis is most often associated with staphylococcal infections of various locations. Compared to the good outcome of classical poststreptococcal glomerulonephritis the severity of the nephritic syndrom is increased and the prognosis is worse, especially if pre-existing renal disease such as diabetic or vascular nephropathy is present. The recognition and adequate therapy, often including surgical measures, of the primary focus of infection is of utmost importance to improve the outcome of this condition. Especially in patients with diabetic foot syndrome and in intravenous drug users with signs of infection and renal insufficiency or abnormal urinalysis, there should be a high index of suspicion for postinfectious glomerulonephritis. © 2015 Verlag Hans Huber, Hogrefe AG, Bern. Source

Thurnheer R.,Kantonsspital
Expert Review of Respiratory Medicine | Year: 2011

Respiratory disorders in sleep are highly prevalent and increasingly recognized. Among these, obstructive sleep apnea, resulting in daytime fatigue and somnolence, increased risk of workplace and traffic accidents but also psychosocial dysfunction, is most often diagnosed. As an independent risk factor for cardiovascular and metabolic disease, obstructive sleep apnea has recently attracted even more attention. Apart from continuous positive airway pressure, only a few alternative treatment options are available. Individual history is still most important for selecting patients for sleep studies. Fatigue and a high subjective propensity to fall asleep during the daytime, a history of snoring and breathing pauses during sleep combined with anthropometric risk factors make a diagnosis very likely. Other night-time respiratory disorders include central sleep apnea, Cheyne-Stokes respiration, obesity hypoventilation syndrome and mixed sleep apnea syndromes. The diagnosis of sleep-disordered breathing can be made by comprehensive sleep studies in a sleep laboratory, but also using portable equipment for cardiorespiratory monitoring and measurement of oxygen desaturation at home, according to pretest probabilities, individual experience and local preferences. © 2011 Expert Reviews Ltd. Source

Brack T.,Kantonsspital | Randerath W.,Witten/Herdecke University | Bloch K.E.,University of Zurich
Respiration | Year: 2012

Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment. Copyright © 2011 S. Karger AG, Basel. Source

Untch M.,HELIOS Klinikum | Loibl S.,German Breast Group | Bischoff J.,Universitats Frauenklinik | Eidtmann H.,Universitats Frauenklinik | And 15 more authors.
The Lancet Oncology | Year: 2012

Background: We compared the efficacy and safety of the addition of lapatinib versus trastuzumab to anthracycline-taxane-based neoadjuvant chemotherapy. Methods: In the GeparQuinto randomised phase 3 trial, patients with untreated HER2-positive operable or locally advanced breast cancer were enrolled between Nov 7, 2007, and July 9, 2010. Patients were eligible if their tumours were classified as cT3/4a-d, or hormone receptor (HR)-negative, HR-positive with clinically node-positive and cT2 disease (cT2 cN+), or HR-positive and pathologically node-positive in the sentinel lymph node for those with cT1 disease (cT1 pN SLN+). Patients were randomly assigned in a 1:1 ratio to receive neoadjuvant treatment with four cycles of EC (epirubicin [90 mg/m 2 intravenously] plus cyclophosphamide [600 mg/m 2 intravenously], every 3 weeks), and four cycles of docetaxel (100 mg/m 2 intravenously every 3 weeks) with either trastuzumab (6 mg/kg intravenously, with a starting loading dose of 8 mg/kg, for eight cycles, every 3 weeks) or lapatinib (1000-1250 mg per day orally) throughout all cycles before surgery. Randomisation was done by dynamic allocation with the minimisation method of Pocock and patients were stratified by participating site, HR status, and extent of disease (cT1-3 cN0-2 vs T4 or N3). The primary endpoint was pathological complete response (defined as ypT0 and ypN0) and was analysed in all patients who received at least one cycle of EC. Participants and investigators were not masked to treatment assignment. Pathologists in centres assessing surgery outcomes were masked to group assignment. This trial is registered with ClinicalTrials.gov, number NCT00567554. Findings: Of 620 eligible patients, 309 were randomly assigned to chemotherapy with trastuzumab (ECH-TH group) and 311 to chemotherapy with lapatinib (ECL-TL group). Two patients in the ECH-TH group and three patients in the ECL-TL group did not start treatment because of withdrawal of consent or immediate surgery. 93 (30·3%) of 307 patients in the ECH-TH group and 70 (22·7%) of 308 patients in the ECL-TL group had a pathological complete response (odds ratio [OR] 0·68 [95%CI 0·47-0·97]; p=0·04). Chemotherapy with trastuzumab was associated with more oedema (119 [39·1%] vs 88 [28·7%]) and dyspnoea (90 [29·6%] vs 66 [21·4%]), and ECL-TL with more diarrhoea (231 [75·0%] vs 144 [47·4%]) and skin rash (169 [54·9%] vs 97 [31·9%]). 43 (14·0%) patients discontinued in the ECH-TH group and 102 (33·1%) in the ECL-TL group. 70 serious adverse events were reported in the ECH-TH group and 87 in the ECL-TL group. Interpretation: This direct comparison of trastuzumab and lapatinib showed that pathological complete response rate with chemotherapy and lapatinib was significantly lower than that with chemotherapy and trastuzumab. Unless long-term outcome data show different results, lapatinib should not be used outside of clinical trials as single anti-HER2-treatment in combination with neoadjuvant chemotherapy. Funding: GlaxoSmithKline, Roche, and Sanofi-Aventis. © 2012 Elsevier Ltd. Source

Gillessen S.,Kantonsspital | Templeton A.,Kantonsspital | Marra G.,University of Zurich | Kuo Y.-F.,University of Texas Medical Branch | And 2 more authors.
Journal of the National Cancer Institute | Year: 2010

BackgroundAndrogen deprivation with gonadotropin-releasing hormone (GnRH) agonists or orchiectomy is a common but controversial treatment for prostate cancer. Uncertainties remain about its use, particularly with increasing recognition of serious side effects. In animal studies, androgens protect against colonic carcinogenesis, suggesting that androgen deprivation may increase the risk of colorectal cancer.MethodsWe identified 107859 men in the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database who were diagnosed with prostate cancer in 1993 through 2002, with follow-up available through 2004. The primary outcome was development of colorectal cancer, determined from SEER files on second primary cancers. Cox proportional hazards regression was used to assess the influence of androgen deprivation on the outcome, adjusted for patient and prostate cancer characteristics. All statistical tests were two-sided.ResultsMen who had orchiectomies had the highest unadjusted incidence rate of colorectal cancer (6.3 per 1000 person-years; 95% confidence interval [CI] = 5.3 to 7.5), followed by men who had GnRH agonist therapy (4.4 per 1000 person-years; 95% CI = 4.0 to 4.9), and men who had no androgen deprivation (3.7 per 1000 person-years; 95% CI = 3.5 to 3.9). After adjustment for patient and prostate cancer characteristics, there was a statistically significant dose-response effect (Ptrend =. 010) with an increasing risk of colorectal cancer associated with increasing duration of androgen deprivation. Compared with the absence of these treatments, there was an increased risk of colorectal cancer associated with use of GnRH agonist therapy for 25 months or longer (hazard ratio [HR] = 1.31, 95% CI = 1.12 to 1.53) or with orchiectomy (HR = 1.37, 95% CI = 1.14 to 1.66).ConclusionLong-term androgen deprivation therapy for prostate cancer is associated with an increased risk of colorectal cancer. © 2010 The Author. Source

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