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Christ-Crain M.,University of Basel | Thomann R.,Buergerspital Solothurn | Zimmerli W.,Kantonsspital Liestal | Hoess C.,Kantonsspital Munsterlingen | Henzen C.,Kantonsspital Lucerne
Diabetologia | Year: 2014

Aims/hypothesis: Despite the condition's high prevalence, the influence of hyperglycaemia on clinical outcomes in non-critical-care inpatients with infections remains ill defined. In this study, we analysed associations of glucose levels at admission and during initial inpatient treatment with the inflammatory response and clinical outcome in community-acquired pneumonia (CAP) patients. Methods: This secondary observational analysis included 880 confirmed CAP patients. We used severity-adjusted multivariate regression models to investigate associations of initial and 96 h mean glucose levels with serially measured biomarker levels over 7 days (C-reactive protein [CRP], procalcitonin, white blood cell count [WBC], pro-adrenomedullin [ProADM]) and adverse clinical course (death and intensive-care unit admission). Results: In the 724 non-diabetic patients (82.3% of the study population), moderate or severe hyperglycaemia (glucose 6-11 mmol/l and >11 mmol/l, respectively) was associated with increased risk for adverse clinical course (adjusted OR [95% CI] 1.4 [0.8, 2.4] and 3.0 [1.1, 8.0], respectively) and with higher CRP, WBC and ProADM levels over 7 days (p < 0.05, ANOVA, all days). In diabetic patients (n = 156), no similar associations were found for initial hyperglycaemia, although mean 96 h glucose levels ≥ 9 mmol/l were associated with adverse clinical course (adjusted OR 5.4 [1.1, 25.8]; p = 0.03). No effect modification by insulin treatment was detected (interaction terms p > 0.2 for all analyses). Conclusions/interpretation: Initial hyperglycaemia in non-diabetic CAP patients, and prolonged hyperglycaemia in diabetic or non-diabetic CAP patients, are associated with a more pronounced inflammatory response and CAP-related adverse clinical outcome. Optimal glucose targets for insulin treatment of hyperglycaemia in non-critical-care settings should be defined. © 2013 Springer-Verlag Berlin Heidelberg.

Kempf W.,Kempf und Pfaltz | Kazakov D.V.,Charles University | Schermesser M.,Dermatology Practice | Buechner S.A.,Histologische Diagnostik and Dermatology Practice | And 4 more authors.
Journal of Cutaneous Pathology | Year: 2012

Mycosis fungoides (MF) is the most common type of cutaneous lymphoma and has protean clinicopathological manifestations. Follicular or folliculotropic MF (FMF) is a rare variant, which histopathologically is characterized by pronounced folliculotropism of neoplastic T cells, with or without follicular mucinosis, and clinically by an impaired prognosis compared to classic MF. In contrast, unilesional MF is a very rare variant with an excellent prognosis, with a single case of large-cell transformation reported to date. The combination of folliculotropic and unilesional MF is very unusual, with only two cases reported to date. Here we report two patients with unilesional folliculotropic MF with progression to tumor stage in both patients. To the best of our knowledge, this is the first report on the disease evolution with large-cell transformation and progression of unilesional FMF. Complete remission was achieved by local radiation therapy in both patients. The differential diagnoses, classification and implications for the treatment of unilesional FMF as well as the pertinent literature are discussed. Copyright © 2012 John Wiley & Sons A/S.

Schoepfer A.M.,McMaster University | Schoepfer A.M.,University of Bern | Gonsalves N.,Northwestern University | Bussmann C.,Kantonsspital Lucerne | And 4 more authors.
American Journal of Gastroenterology | Year: 2010

OBJECTIVES: Esophageal dilation often leads to long-lasting relief of dysphagia in eosinophilic esophagitis (EoE). The aim of this study was to define the effectiveness, safety, and patient acceptance of esophageal dilation in EoE. In addition, we examined the influence of dilation on the underlying esophageal inflammation.METHODS: Two databases including 681 EoE patients were reviewed. Cohort 1 consisted of patients treated with dilation alone, whereas cohort 2 included patients treated with a combination of dilation and antieosinophilic medication. Patients from cohort 1 underwent a prospective histological reexamination and an evaluation using a questionnaire.RESULTS: In total, 207 EoE patients were treated with esophageal dilation, 63 in cohort 1 and 144 in cohort 2. Dilation led to a significant increase in esophageal diameter and to an improvement in dysphagia in both the cohorts (P0.001). After dilation, dysphagia recurred after 2322 months in cohort 1 and 2014 months in cohort 2. No esophageal perforation or major bleeding occurred. Among the patients surveyed, 74% reported retrosternal pain after dilation; however, all were agreeable to repeated dilation if required. Eosinophil peak infiltration, eosinophil load, and EoE-associated histological signs were not significantly affected by esophageal dilation.CONCLUSIONS: Esophageal dilation is highly effective in providing long-lasting symptom relief and can be performed safely with a high degree of patient acceptance. However, dilation is associated with postprocedural pain in most patients and does not influence the underlying inflammatory process. Symptom improvement despite persistence of inflammation suggests that tissue remodeling contributes substantially to symptom generation in EoE. © 2010 by the American College of Gastroenterology.

Wijk S.S.-V.,Maastricht University | Maeder M.T.,Kantonsspital St. Gallen | Nietlispach F.,University of Bern | Rickli H.,Kantonsspital St. Gallen | And 6 more authors.
Circulation: Heart Failure | Year: 2014

Background.Therapy guided by N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels may improve outcomes in patients with chronic heart failure (HF), especially in younger patients with reduced left ventricular ejection fraction. It remains unclear whether treatment effects persist after discontinuation of the NT-proBNP.guided treatment strategy. Methods and Results.Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure randomized 499 patients with HF aged .60 years with left ventricular ejection fraction .45% to intensified, NT- proBNP. guided versus standard, symptom-guided therapy into prespecified age groups (60.74 and .75 years) during 18 months. A total of 329 patients (92%) alive at 18 months agreed to long-term follow-up. HF medication was intensified to a larger extent in the NT-proBNP.guided group. During long-term, NT-proBNP.guided therapy did not improve hospital- free (primary end point: hazard ratio, 0.87; 95% confidence interval,; P=0.16) or overall survival (hazard ratio, 0.85; 95% confidence interval,; P=0.25) but did improve HF hospitalization-free survival (hazard ratio, 0.70; 95% confidence interval,; P=0.005). Patients aged 60 to 74 years had benefit from NT-proBNP.guided therapy on the primary end point and HF hospitalization-free survival, whereas patients aged .75 years did not (P<0.10 for interaction). In landmark analysis, there was no regression to the mean after cessation of the NT-proBNP.guided strategy. More intensified HF medication at month 12 was associated with better long-term HF hospitalization-free and overall survival. Conclusions.Intensified, NT-proBNP.guided therapy did not improve the primary end point compared with symptomguided therapy but did improve HF hospitalization-free survival. Within the subgroup of patients aged 60 to 74 years, it improved clinical outcome including the primary end point. These effects did not disappear after cessation of the NTproBNP. guided strategy on the long-term. This is possibly attributable to a more intensified HF medical therapy in the NT-proBNP.guided group. © 2013 American Heart Association, Inc.

Brunner-La Rocca H.-P.,University of Basel | Brunner-La Rocca H.-P.,Maastricht University | Rickenbacher P.,University Hospital Bruderholz | Muzzarelli S.,University of Basel | And 9 more authors.
European Heart Journal | Year: 2012

Aims Elderly heart failure (HF) patients are assumed to prefer improved quality of life over longevity, but sufficient data are lacking. Therefore, we assessed the willingness to trade survival time for quality-of-life (QoL) and the preferences for resuscitation.Methods and resultsAt baseline and after 12 and 18 months, 622 HF patients aged <60 years (77 ± 8 years, 74 NYHA-class

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