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.
Christ-Crain M.,University of Basel |
Thomann R.,Burgerspital Solothurn |
Hoess C.,Kantonsspital Munsterlingen |
Henzen C.,Luzerner Kantonsspital |
And 2 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2015
Background: The added value of biomarkers, such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC), as adjuncts to clinical risk scores for predicting the outcome of patients with community-acquired pneumonia (CAP) is in question. We investigated the prognostic accuracy of initial and follow-up levels of inflammatory biomarkers in predicting death and adverse clinical outcomes in a large and well-defined cohort of CAP patients. Methods: We measured PCT, CRP and WBC on days 1, 3, 5, and 7 and followed the patients over 30 days. We applied multivariate regression models and area under the curve (AUC) to investigate associations between these biomarkers, the clinical risk score CURB-65, and clinical outcomes [i.e., death and intensive care unit (ICU) admission]. Results: Of 925 patients with CAP, 50 patients died and 118 patients had an adverse clinical outcome. None of the initial biomarker levels significantly improved the CURB-65 score for mortality prediction. Follow-up biomarker levels showed significant independent association with mortality at days 3, 5, and 7 and with improvements in AUC. Initial PCT and CRP levels were independent prognostic predictors of adverse clinical outcome, and levels of all biomarkers during the course of disease provided additional prognostic information. Conclusions: This study provides robust insights into the added prognostic value of inflammatory markers in CAP. Procalcitonin, CRP, and to a lesser degree WBC provided some prognostic information on CAP outcomes, particularly when considering their kinetics at days 5 and 7 and when looking at adverse clinical outcomes instead of mortality alone. © 2015 by De Gruyter.
Muller F.,University of Basel |
Christ-Crain M.,University of Basel |
Bregenzer T.,Kantonsspital |
Krause M.,Kantonsspital Munsterlingen |
And 3 more authors.
Chest | Year: 2010
Background: Guidelines recommend blood culture sampling from hospitalized patients with suspected community-acquired pneumonia (CAP). However, the yield of true-positive results is low. We investigated the benefit of procalcitonin (PCT) on hospital admission to predict blood culture positivity in CAP. Methods: This was a prospective cohort study with a derivation and validation set including 925 patients with CAP who underwent blood culture sampling on hospital admission. Results: A total of 73 (7.9%) patients had true bacteremia (43 of 463 in the derivation cohort, 30 of 462 in the validation cohort). The area under the receiver operating characteristics curve of PCT in the derivation and validation cohorts was similar (derivation cohort, 0.83; 95% CI, 0.78-0.89; validation cohort, 0.79; 95% CI, 0.72-0.88). Overall, PCT was a significantly better predictor for blood culture positivity than WBC count, C-reactive protein, and other clinical parameters. In multivariate regression analysis, only antibiotic pretreatment (adjusted odds ratio, 0.25; P<.05) and PCT serum levels (adjusted odds ratio, 3.72; P<.001) were independent predictors. Overall, a PCT cutoff of 0.1 μg/L would enable reduction of the total number of blood cultures by 12.6% and still identify 99% of the positive blood cultures. Similarly, 0.25 μg/L and 0.5 μg/L cutoffs would enable reduction of blood cultures by 37% and 52%, respectively, and still identify 96% and 88%, respectively, of positive blood cultures. Conclusions: Initial PCT level accurately predicted blood culture positivity in patients with CAP. PCT measurement has the potential to reduce the number of drawn blood cultures in the emergency department and to implement a more targeted allocation of limited health-care resources. © 2010 American College of Chest Physicians.
Wissel J.,Kliniken Beelitz GmbH |
Schelosky L.D.,Kantonsspital Munsterlingen |
Scott J.,Kliniken Beelitz GmbH |
Christe W.,Ernst von Bergmann Hospital |
And 2 more authors.
Journal of Neurology | Year: 2010
This study followed a cohort of 103 patients at median 6 days, 6 and 16 weeks after stroke and recorded muscle tone, pain, paresis, Barthel Index and quality of life score (EQ-5D) to identify risk-factors for development of spasticity. 24.5% of stroke victims developed an increase of muscle tone within 2 weeks after stroke. Patients with spasticity had significantly higher incidences of pain and nursing home placement and lower Barthel and EQ-5D scores than patients with normal muscle tone. Early predictive factors for presence of severe spasticity [modified Ashworth scale score (MAS) ≥ 3] at final follow-up were moderate increase in muscle tone at baseline and/or first follow-up (MAS = 2), low Barthel Index at baseline, hemispasticity, involvement of more than two joints at first follow-up, and paresis at any assessment point. The study helps to identify patients at highest risk for permanent and severe spasticity, and advocates for early treatment in this group. © 2010 The Author(s).
Fietzek U.M.,Schon Klinik Munich Schwabing |
Kossmehl P.,Neurological Rehabilitation Medical Center |
Schelosky L.,Kantonsspital Munsterlingen |
Ebersbach G.,Kliniken Beelitz |
Wissel J.,Vivantes Klinikum Spandau
European Journal of Neurology | Year: 2014
Background and purpose: Spastic pes equinovarus is a frequent pathological posture of the lower extremity. Botulinum toxin (BoNT/A) has been successfully applied to treat lower limb spasticity. However, the best time to initiate treatment remains unclear. A beneficial effect of an early treatment has been suggested in previous studies. Methods: A single-centre double-blind randomized placebo-controlled trial was performed to investigate the efficacy of BoNT/A to reduce muscle hypertonicity at the ankle. Fifty-two patients with unilateral or bilateral spastic pes equinovarus with a modified Ashworth score (mAS) of at least 1+ after stroke, traumatic brain injury or hypoxic encephalopathy were allocated to receive either BoNT/A or placebo treatment. A second, open injection was optional at week 12. Patients received unilateral or bilateral injections with 230 or 460 U onabotulinumtoxinA, respectively. The course of the mAS was explored during the open study phase. Results: Patients who had received BoNT/A treatment had lower mAS compared with placebo at week 12 (P < 0.01). During the open label phase, patients from the placebo group showed further deterioration of muscle tone despite starting from a similar baseline and receiving BoNT treatment. Spastic feet that had received BoNT/A in the first cycle had comparatively lower mAS scores over all follow-up data and at week 24 (P < 0.01). Conclusions: The study demonstrates a reduction of muscular hypertonicity in spastic pes equines with BoNT/A treatment given during the first 3 months after the lesion. Exploratory analyses of the course of muscular hypertonicity during the open phase favour earlier to later treatment. © 2014 EAN.
Rimbach S.,Kantonsspital Munsterlingen |
Holzknecht A.,Landeskrankenhaus Feldkirch |
Nemes C.,Institute of Pathology |
Offner F.,Institute of Pathology |
Craina M.,Polytechnic University of Timişoara
Archives of Gynecology and Obstetrics | Year: 2015
Introduction: Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures. Material and methods: The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies. Results: The main results on n = 8 procedures with in-bag morcellation compared to n = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min (P = 0.0052; 95 % confidence interval 4.64–21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag (P = 0.0256). Conclusion: Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application. © 2015, Springer-Verlag Berlin Heidelberg.
Benz R.,Kantonsspital Munsterlingen |
Schanz U.,University of Zürich |
Maggiorini M.,University of Zürich |
Seebach J.D.,University of Geneva |
Stussi G.,Oncology Institute of Southern Switzerland
Bone Marrow Transplantation | Year: 2014
A considerable number of patients undergoing allogeneic hematopoietic SCT (HSCT) develop post-transplant complications requiring intensive care unit (ICU) treatment. Whereas the indications and the outcome of ICU admission are well known, the risk factors leading to ICU admission are less well understood. We performed a retrospective single-center study on 250 consecutive HSCT patients analyzing the indications, risk factors and outcome of ICU admission. Of these 250 patients, 33 (13%) were admitted to the ICU. The most common indications for admission to the ICU were pulmonary complications (11, 33%), sepsis (8, 24%), neurological disorders (6, 18%) and cardiovascular problems (2, 6%). Acute GvHD and HLA mismatch were the only significant risk factors for ICU admission in multivariate analysis. Among patients admitted to the ICU, the number of organ failures correlated negatively with survival. Twenty-one (64%) patients died during the ICU stay and the 6-month mortality was 85% (27 out of 33). SAPS II score underestimated the mortality rate. In conclusion, acute GvHD and HLA mismatch were identified as risk factors for ICU admission following allogeneic HSCT. Both, short- and long-term survival of patients admitted to the ICU remains dismal and depends on the number of organ failures.
Fierz F.C.,Spital Davos |
Kistler W.,Spital Davos |
Stenz V.,Kantonsspital Munsterlingen |
Gubler C.,Universitatsspital Zurich
Case Reports in Gastroenterology | Year: 2013
Acute esophageal variceal bleeding in patients with portal hypertension remains a complication with a high mortality today. In cases refractory to standard therapy including endoscopic band ligation and pharmacological therapy, traditionally balloon tamponade has been used as salvage therapy. However, these techniques show several important limitations. Self-expanding metal stents (SEMS) have been proposed as an alternative rescue treatment. The use of variceal stenting in 7 patients with a total of 9 bleeding episodes in three different Swiss hospitals is demonstrated. While immediate bleeding control is achieved in a high percentage of cases, the 5-day and 6-week mortality rate remain high. Mortality is strongly influenced by the severity of the underlying liver disease. Accordingly, our data represent a high-risk patient collective. Thanks to their safety and easy handling, SEMS are an interesting alternative to balloon tamponade as a bridging intervention to definitive therapy including the pre-hospital setting. © 2013 S. Karger AG, Basel.
Ampofo C.,Kantonsspital Munsterlingen |
Aerni M.,Kantonsspital Munsterlingen
Handchirurgie Mikrochirurgie Plastische Chirurgie | Year: 2011
Purpose: In the following article we present our results with a cemented titanium/polyethylene prosthesis. Patients and Methods: The SR TM-PIP-prosthesis from the firm SBI (formally Avanta) was implanted in 39 patients in our clinic from 20012007. In all, we were able to follow-up in a retrospect clinical study 32 patients with 39 proximal interphalangeal joint prostheses. We examined the range of motion, the strength and looked for deformities. The patients had to fill in a questionnaire before examination about their pain and limitation in daily life. We also performed X-rays of the operated fingers. Results: The postoperative range of motion was about 67. The strength mean value was 24.7kg. 4 patients needed surgical revisions, in one case due to loosening of the proximal part of the prosthesis. 2 patients also received a tenoarthrolysis because of extension deficits and one patient because of a swan-neck deformity. We noted 7 swan-neck deformities and in 7 cases we found implant loosening of the proximal part of the prothesis. The postoperative Quick-DASH score was about 32.2 and showed a good result. All participants reported a marked improvement in pain reduction. Conclusion: These positive results, the reduction of pain and the satisfaction of the patients advocate the use of this prosthesis for the proximal interphalangeal joint. The postoperative ROM is comparable to those of other prostheses. Concerning implant loosening and swan-neck deformity, these results still offer room for improvement. Critical judgement and further development of the prosthesis design, the operation technique and the instrumentation are required to further optimise the results. © 2011 Georg Thieme Verlag KG Stuttgart New York.
Morell B.K.,Kantonsspital Munsterlingen
BMJ case reports | Year: 2010
We report the case of a young man with a history of attention deficit/hyperactivity disorder and mild cognitive impairment who presented with chronic fatigue, anorexia and progressive darkening of the skin. On laboratory testing, severely depressed concentrations of morning cortisol, along with highly elevated values of adrenocorticotropic hormone (ACTH) revealed primary adrenal insufficiency as the primary cause of the patient's symptomatology. Imaging of the brain showed altered signal intensities in the parieto-occipital regions of the brain. The demonstration of increased very long chain fatty acids (VLCFA) established the diagnosis of adolescent X-linked adrenoleukodystrophy (X-ALD). Presenting at an advanced yet slowly progressive stage the patient was not a suitable candidate for haematopoietic stem cell transplantation (HSCT), and treatment focused on hormone replacement therapy, family counselling and supportive care. On follow-up visits within the following year, fatigue had diminished and there was no evidence of progressive neurological deficits. However, exacerbation of the psychiatric symptomatology resulted in admittance to a psychiatric ward.