Staehelin C.,University of Bern |
Keiser O.,University of Bern |
Calmy A.,University of Geneva |
Weber R.,University of Zürich |
And 5 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2012
Objectives: Persons from sub-Saharan Africa (SSA) are increasingly enrolled in the Swiss HIV Cohort Study (SHCS). Cohorts from other European countries showed higher rates of viral failure among their SSA participants. We analyzed long-term outcomes of SSA versus North Western European participants. Design: We analyzed data of the SHCS, a nation-wide prospective cohort study of HIV-infected adults at 7 sites in Switzerland. Methods: SSA and North Western European participants were included if their first treatment combination consisted of at least 3 antiretroviral drugs (cART), if they had at least 1 follow-up visit, did not report active injecting drug use, and did not start cART with CD4 counts >200 cells per microliter during pregnancy. Early viral response, CD4 cell recovery, viral failure, adherence, discontinuation from SHCS, new AIDS-defining events, and survival were analyzed using linear regression and Cox proportional hazard models. RESULTS: The proportion of participants from SSA within the SHCS increased from 2.6% (<1995) to 20.8% (2005-2009). Of 4656 included participants, 808 (17.4%) were from SSA. Early viral response (6 months) and rate of viral failure in an intent-to-stay-on-cART approach were similar. However, SSA participants had a higher risk of viral failure on cART (adjusted hazard ratio: 2.03, 95% confidence interval: 1.50 to 2.75). Self-reported adherence was inferior for SSA. There was no increase of AIDS-defining events or mortality in SSA participants. Conclusions: Increased attention must be given to factors negatively influencing adherence to cART in participants from SSA to guarantee equal longer-term results on cART.
Van Den Berg J.C.,Ospedale Regionale di Lugano
Vascular Disease Management | Year: 2013
The use of three-dimensional (3D) image guidance for endovascular procedures has increased over the last decade. This paper will discuss the background of the development of 3D rotational angiography and live 3D-roadmap techniques based on selective 3D rotational angiography. This paper will describe in more detail the application of novel 3D navigation tools, including the use of cone-beam CT and the use of merging techniques that allow for fusion of CT angiographic images and fluoroscopy. The technique and prerequisites for image fusion as well as advantages, disadvantages, and pitfalls will be discussed.
Schmidhauser T.,Ospedale Regionale di Lugano |
Curioni S.,Ospedale Regionale di Lugano |
Bernasconi E.,Ospedale Regionale di Lugano
Canadian Journal of Infectious Diseases and Medical Microbiology | Year: 2013
Anicteric leptospirosis is a self-limited flu-like disease, whereas the icteric form is a severe illness characterized by multiple organ involvement or even failure. A case involving a patient with rapidly progressing renal insufficiency requiring intermittent renal replacement therapy due to Leptospira grippotyphosa in the absence of a Weil's disease is reported. ©2013 Pulsus Group Inc. All rights reserved.
Fioole B.,St Antonius Hospital |
van de Rest H.J.M.,St Antonius Hospital |
Meijer J.R.M.,St Antonius Hospital |
van Leersum M.,St Antonius Hospital |
And 4 more authors.
Journal of Vascular Surgery | Year: 2010
Purpose: Open revascularization in patients with chronic mesenteric ischemia (CMI) is considered the gold standard. Percutaneous transluminal angioplasty and stenting (PTAS) is often reserved for patients not suitable for open revascularization. In our institute, endovascular revascularization is the first-choice treatment. The purpose of this study was to report the technical and clinical success rates after endovascular revascularization as the first-choice treatment in a series of 51 consecutive patients with CMI at a single tertiary vascular referral center. Methods: A retrospective review was performed of all consecutive patients with CMI who underwent PTAS from July 2001 to July 2008. Only symptomatic patients treated for atherosclerotic CMI were included. Patency was evaluated using computed tomography angiography (CTA). Kaplan-Meier curves were used to calculate patency rates of the treated mesenteric arteries. Results: Sixty mesenteric arteries (30 celiac trunks, 24 superior mesenteric, and 6 inferior mesenteric arteries) were treated in 51 patients (26 men). Major morbidity was 4%. After dissection of the superior mesenteric artery (n = 1) and brachial artery (n = 1), respectively, both patients underwent endarterectomy and patch plasty. In three arteries, the lesion could not be crossed endovascularly and they were deemed immediate intention-to-treat failures. The initial technical success rate was 93%. No 30-day mortality was observed. Median follow-up was 25 months. During follow-up, 2 patients died from intestinal ischemia. Complete symptom relief was achieved in 78% of patients. Primary 1- and 2-year patency rates were 86% ± 5% and 60% ± 9%, respectively; primary-assisted patency rates were 88% ± 5% and 79% ± 7%, respectively. During follow-up, 6 patients underwent open revascularization due to failure of PTAS. Conclusion: The initial technical success rate of PTAS as first-choice treatment of CMI is >90%. The 2-year primary patency rate dropped to 60%, but symptomatic in-stent stenoses could often be treated successfully with renewed endovascular techniques. Including one conversion, 14% of patients needed open revascularization during follow-up. © 2010 Society for Vascular Surgery.
De Spirito D.,Ospedale Regionale di Lugano
Techniques in Hand and Upper Extremity Surgery | Year: 2013
Closed percutaneous wire fixation of hand fractures frequently requires protection with external splintage. This splintage increases the risk of joint stiffness, prolongs recovery time, and increases therapy input. We have developed a method of linking external Kirschner wires (K-wires), using a metal clamp, after their insertion, so as to increase the security of fixation and facilitate postoperative mobilization. The mechanical properties of this method have been assessed in vitro and compared with conventionally fixed, unlinked, K-wires. We have been able to establish that the linked K-wire system is better able to resist loosening. This work proposes that linkage of K-wires permits omission of all additional external splintage, with no detriment to management. The technique has been applied in clinical cases over the past 8 years and results of treatments were evaluated mainly to detect unexpected complications. We report a low rate of complications and good results in terms of bone healing and recovery of function. © 2013 by Lippincott Williams and Wilkins.
A prospective, double-blinded, randomized, clinical trial comparing the efficacy of 40 Mg and 60 Mg hyperbaric 2% prilocaine versus 60 Mg plain 2% prilocaine for intrathecal anesthesia in ambulatory surgery
Camponovo C.,Ospedale Regionale di Lugano |
Fanelli A.,University of Parma |
Ghisi D.,University of Parma |
Cristina D.,Ospedale Regionale di Lugano |
Fanelli G.,University of Parma
Anesthesia and Analgesia | Year: 2010
Background: In this prospective, double-blind, randomized trial we compared 60 mg and 40 mg of 2% hyperbaric prilocaine with 60 mg of 2% plain prilocaine for spinal anesthesia in terms of sensory block onset in outpatients undergoing elective short-duration (<60 minutes) surgery under spinal anesthesia. Methods: Ninety patients were enrolled and randomly allocated to receive 1 of the 3 treatments. Times to sensory and motor block onsets, time to the maximum sensory block level, readiness for surgery, time to first urinary voiding, time to Bromages score 0, and side effects were registered blindly. A blinded observer also questioned patients about transient neurological symptoms 24 hours and 7 days after spinal anesthesia. Results: Mean times to achieve a T10 level of sensory block were comparable in the 3 groups. However, 20% of patients receiving plain prilocaine did not achieve a T10 level. The 2 hyperbaric dosages (60 mg and 40 mg) showed significantly faster times to motor block onset (P = 0.0091, P = 0.0097), to the maximum sensory block level (P = 0.0297, P = 0.0183), to motor block offset (P = 0.0004, P < 0.0001), and to first urinary voiding (P = 0.0013, P = 0.0002, respectively) than did plain prilocaine. No major adverse reactions or transient neurological symptoms were observed in the study. Conclusions: Spinal anesthesia with 60 mg or 40 mg of 2% hyperbaric prilocaine is comparable to 60 mg of 2% plain prilocaine in terms of onset of sensory block at T10. The hyperbaric solution showed faster times to motor block onset and shorter duration of surgical block, suggesting its superiority for the ambulatory setting. © 2010 International Anesthesia Research Society.
PubMed | Ospedale Regionale di Lugano and SSD Chirurgia Articolare del Ginocchio Instituto Ortopedico Gaetano Pini
Type: Journal Article | Journal: The Knee | Year: 2016
This study aimed to assess the reliability of the Maioregen biomimetic osteochondral scaffold (Finceramica Faenza SpA, Faenza, Italy) as a salvage and joint-preserving procedure in the treatment of late-stage osteonecrosis of the knee.Eleven active patients aged under 65years and presenting with clinical and radiological signs of SPONK were treated with Maioregen. All were clinically evaluated pre-operatively and yearly thereafter for a minimum of two years. Subjective IKDC and Lysholm Knee Scale scores were used to assess clinical outcome. A VAS scale served to quantify pre-operative pain and post-operative pain. Activity levels were evaluated pre-operatively and at follow-up using the Tegner Activity Scale.Subjective IKDC (4015.0 to 65.714.8 (meanSD)) and Lysholm Knee Scale (49.717.9 to 86.612.7 (meanSD)) scores improved significantly from pre-operative evaluation (p<.01). VAS scores decreased from a pre-operative mean (SD) of 6.32.5 to 1.62.7 at two years. The Tegner Activity Scale showed no significant differences between pre-injury and two-year follow-up. Two out of the 11 patients were symptomatic at 18months post implant and progressed to condylar collapse. These patients required total knee arthroplasty.Use of a biomimetic scaffold can be a valid option in the surgical treatment of SPONK in relatively young active patients. Indeed, this surgical technique, originally developed for osteochondritis dissecans, has been found to give good clinical results at medium-term follow-up of late-stage osteonecrosis treatment and could postpone or even avoid the need for joint replacement procedures.
PubMed | University of Verona and Ospedale Regionale di Lugano
Type: | Journal: Annals of vascular surgery | Year: 2016
Infective aortitis (IA) and penetrating aortic ulcer (PAU) impending for rupture represent 2 hostile life-threatening conditions. Simultaneous presentations of these rare entities can be considered an exception. The pleomorphic clinical presentation and the multifactorial etiology require a multidisciplinary approach to reach a correct diagnosis and an urgent treatment. We report the case of a 65-year-old patient presented with acute abdominal pain and septic shock secondary to a bacterial aortitis and penetrating ulcer of abdominal aorta. Unfit for surgery due to severe comorbidities, he was treated by means of a tubular endograft and long-term antibiotic therapy. A rapid improvement of clinical conditions was observed during the subsequent hospital stay. Complete regression of aortic involvement was demonstrated after 1 year. In conclusion, for selected patients affected by IA and PAU an endovascular approach associated to long-term antibiotic therapy may be safe and effective.
PubMed | Ospedale Regionale di Lugano and University of Zürich
Type: Journal Article | Journal: European journal of radiology | Year: 2016
To assess differences in fat signal fraction (FSF) in skeletal muscle as determined by two-point Dixon technique at 3T before and after application of intravenous gadoterate meglumide (Gd-DOTA).Eight patients (mean age, 50.8 years; range, 41-72 years) underwent clinical whole-body MRI at 3T for myopathic symptoms. Two-point Dixon technique based T1-weighted turbo spin-echo images were acquired before and after the administration of intravenous Gd-DOTA. On both image sets, the FSF was calculated in the gluteus medius, gluteus maximus, and quadriceps muscles bilaterally. Pre- and post-contrast FSF values were compared by linear regression, Bland-Altman plot as well as paired Student t-tests with Bonferroni correction.The mean pre- and post-contrast FSF of included muscles were 28.7%14.9% and 27.8%15.1%, respectively. Linear regression indicated almost equivalent FSF estimation between pre- and post-contrast measurements (sum of squared residuals R(2), 0.920.04; slope, 0.97; X-intercept, -0.05; Y-intercept, +0.05). The Bland-Altman plot revealed a minimal systematical bias of the post-contrast FSF measurements of -0.87%. Paired Student t-tests did not reveal significant differences (overall p-value, 0.168).Gd-DOTA does not significantly influence FSF quantification in skeletal muscle based on the two-point Dixon technique at 3T.
PubMed | Ospedale Regionale di Lugano.
Type: Case Reports | Journal: Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica | Year: 2016
We present the case of a 21 year old patient with an incomplete tear of the tunica albuginea occurred after violent masturbation. The diagnostic assessment was performed first clinically, then with ultrasound and with 3 Tesla MRI. 3 Tesla MRI, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, we were able to perform a selective minimally invasive surgical approach to repair the lesion.