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Baden, Switzerland

Heesen M.,Kantonsspital Baden | Klimek M.,Erasmus Medical Center
Current Opinion in Anaesthesiology | Year: 2016

Purpose of review Nonobstetric anesthesia during pregnancy is challenging-not only for the anesthetist. Owing to the difficulties of ethical consent for randomized studies in this special patient group, the available evidence is quite low. Nevertheless, recently several guidelines for the management of pregnant patients undergoing nonobstetric anesthesia have been published. We review the current guidelines developed under the auspices of the Society of American Gastrointestinal Endoscopic Surgeons, guidelines for the management of difficult and failed tracheal intubation in obstetrics, as well as guidelines for the management of a pregnant trauma patient. Recent findings The algorithms for management of the difficult airway during pregnancy should be made available in every institution that cares for pregnant women. During laparoscopic surgery strict limitation of the pneumoperitoneal pressure to avoid maternal hypercapnia and fetal acidosis is strongly recommended. An injured pregnant woman should be transferred to a maternity facility when the injury is not life or limb threatening. In case of major trauma, stabilization and care of the woman is priority. Summary Several guidelines with high relevance for the care of pregnant women undergoing nonobstetric surgery have been published. Although the level of evidence may be low they can probably contribute to an improvement in the care and outcome of this patient group. © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Schoepfer A.M.,University of Lausanne | Safroneeva E.,University of Bern | Bussmann C.,Viollier AG | Kuchen T.,University of Zurich | And 4 more authors.
Gastroenterology | Year: 2013

Background & Aims Development of strictures is a major concern for patients with eosinophilic esophagitis (EoE). At diagnosis, EoE can present with an inflammatory phenotype (characterized by whitish exudates, furrows, and edema), a stricturing phenotype (characterized by rings and stenosis), or a combination of these. Little is known about progression of stricture formation; we evaluated stricture development over time in the absence of treatment and investigated risk factors for stricture formation. Methods We performed a retrospective study using the Swiss EoE Database, collecting data on 200 patients with symptomatic EoE (153 men; mean age at diagnosis, 39 ± 15 years old). Stricture severity was graded based on the degree of difficulty associated with passing of the standard adult endoscope. Results The median delay in diagnosis of EoE was 6 years (interquartile range, 2-12 years). With increasing duration of delay in diagnosis, the prevalence of fibrotic features of EoE, based on endoscopy, increased from 46.5% (diagnostic delay, 0-2 years) to 87.5% (diagnostic delay, >20 years; P =.020). Similarly, the prevalence of esophageal strictures increased with duration of diagnostic delay, from 17.2% (diagnostic delay, 0-2 years) to 70.8% (diagnostic delay, >20 years; P <.001). Diagnostic delay was the only risk factor for strictures at the time of EoE diagnosis (odds ratio = 1.08; 95% confidence interval: 1.040-1.122; P <.001). Conclusions The prevalence of esophageal strictures correlates with the duration of untreated disease. These findings indicate the need to minimize delay in diagnosis of EoE. © 2013 by the AGA Institute.

Winterhalder R.,Kantonsspital Luzern | Hoesli P.,Etablissements Hospitaliers Nord Vaudois | Delmore G.,Kantonsspital Frauenfeld | Pederiva S.,Kantonsspital Baden | And 3 more authors.
Oncology | Year: 2011

Objectives: While oral anticancer treatment has increased the convenience for patients with no risk of venous access complications compared to intravenous drug administration, a high level of compliance cannot always be assumed. The aim of the present report was to evaluate real-life drug adherence in a prospective cohort analysis of patients with gastrointestinal or breast cancer treated with capecitabine-based chemotherapy. Methods: Twenty-nine Swiss oncologists recruited patients receiving capecitabine, either as monotherapy or in combination with other chemotherapeutic agents, in a prospective fashion. Patients recorded both their capecitabine intake and any adverse effects each day in patient diaries. Results: A total of 177 patients were included, 143 (81%) with gastrointestinal tumours and 34 (19%) with breast cancer. Overall, 161 patients (91%) were considered as fully compliant, while 16 patients (9%) reported some kind of compliance error. Reasons for non-compliance included forgetting to take treatment (n = 9), side effects (n = 4) and misunderstanding instructions (n = 3). Self-reported compliance was not influenced by age or Eastern Cooperative Oncology Group performance status, but there was a trend towards better compliance with capecitabine therapy if fewer adverse effects occurred (p = 0.07, simple logistic regression). Conclusions: Self-reported compliance with capecitabine-based therapy in clinical practice is high and seems to be adversely affected by side effects. © 2011 S. Karger AG, Basel.

Wang Z.,Paul Scherrer Institute | Hauser N.,The Interdisciplinary Center | Singer G.,Institute of Pathology | Trippel M.,Institute of Pathology | And 4 more authors.
Nature Communications | Year: 2014

Microcalcifications can be indicative in the diagnosis of early breast cancer. Here we report a non-invasive diagnostic method that may potentially distinguish between different types of microcalcifications using X-ray phase-contrast imaging. Our approach exploits the complementary nature of the absorption and small-angle scattering signals of microcalcifications, obtained simultaneously with an X-ray grating interferometer on a conventional X-ray tube. We demonstrate that the new approach has 100% sensitivity and specificity when applied to phantom data, and we provide evidence of the solidity of the technique by showing its discrimination power when applied to fixed biopsies, to non-fixed tissue specimens and to fresh, whole-breast samples. The proposed method might be further developed to improve early breast cancer diagnosis and has the potential to increase the diagnostic accuracy and reduce the number of uncomfortable breast biopsies, or, in case of widespread microcalcifications, to select the biopsy site before intervention. © 2014 Macmillan Publishers Limited. All rights reserved.

Stampanoni M.,Paul Scherrer Institute | Stampanoni M.,ETH Zurich | Wang Z.,Paul Scherrer Institute | Thuring T.,Paul Scherrer Institute | And 7 more authors.
Investigative Radiology | Year: 2011

Objectives: Phase-contrast and scattering-based X-ray imaging are known to provide additional and complementary information to conventional, absorption-based methods, and therefore have the potential to play a crucial role in medical diagnostics. We report on the first mammographic investigation of 5 native, that is, freshly dissected, breasts carried out with a grating interferometer and a conventional X-ray tube source. Four patients in this study had histopathologically proven invasive breast cancer. One male patient, without the presence of any malignant formations within the resected breast, was included as a control specimen. MATERIALS AND METHODS:: We used a Talbot-Lau grating setup installed on a conventional, low-brilliance X-ray source; the interferometer operated at the fifth Talbot distance, at a tube voltage of 40 kVp with mean energy of 28 keV, and at a current of 25 mA. The device simultaneously recorded absorption, differential phase and small-angle scattering signals from the native breast tissue. These quantities were then combined into novel color-and high-frequency-enhanced radiographic images. Presurgical images (conventional mammography, ultrasonography, and magnetic resonance imaging) supported the findings and clinical relevance was verified. RESULTS:: Our approach yields complementary and otherwise inaccessible information on the electron density distribution and the small-angle scattering power of the sample at the microscopic scale. This information can be used to potentially answer clinically relevant, yet unresolved questions such as unequivocally discerning between malignant and premalignant changes and postoperative scars and distinguishing cancer-invaded regions within healthy tissue. CONCLUSIONS:: We present the first ex vivo images of fresh, native breast tissue obtained from mastectomy specimens using grating interferometry. This technique yields improved diagnostic capabilities when compared with conventional mammography, especially when discerning the type of malignant conversions and their breadth within normal breast tissue. These promising results advance us toward the ultimate goal, using grating interferometry in vivo on humans in a clinical setting. © 2011 by Lippincott Williams & Wilkins.

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