Giovacchini G.,Stadtspital Triemli |
Breeuwsma A.J.,University of Groningen
Quarterly Journal of Nuclear Medicine and Molecular Imaging | Year: 2012
PET/CT with either [11C]choline or [18F]fluorocholine represents a powerful technique for restaging prostate cancer (PCa) patients with biochemical failure. The availability of dedicated PET/CT scanners allows fusioning of morphological and functional images, which enables accurate localization of sites of pathological tracer uptake and ease the differentiation between malignant and benign findings. A noteworthy advantage of this whole-body technique is that it provides information on multiple anatomic sites at a single time. As such, the technique has the capability of distinguishing between local relapse and distant metastases, and therefore has the potential to guide the medical treatment. The positive detection rate of [ 11C]choline PET/CT varies substantially in relation to the inclusion criteria. Studies which included unselected consecutive patients reported a positive detection rate ranging between 40% and 70%. Serum PSA level represents the single, most important factor affecting the rate of positive scans. Other positive predicitive factors include fast PSA kinetics (PSA velocity, PSA doubling time), advanced pathological state at initial staging, previous biochemical failure, hormone resistance and older age. Recent studies indicate that [11C]choline PET/CT has the potential to early restaging PCa patients for PSA levels lower than 1-1.5 ng/mL. However, more studies are necessary to better define the potential of this technique for low PSA levels. The previously cited risk factors can be used to identify patients that are at greater risk and that might best benefit from PET/CT scans. Patients that develop biochemical failure during androgen deprivation therapy (hormone resistance) have a higher likelihood for a positive [11C]choline PET/CT scan in comparison to patients that are drug naïve (hormone sensitive) and are not required to withdraw the anti-androgenic treatment before PET/CT.
Radovanovic D.,University of Zürich |
Seifert B.,University of Zürich |
Eberli F.R.,Stadtspital Triemli |
Rickli H.,Kantonsspital St. Gallen |
And 3 more authors.
Heart | Year: 2014
Objective This study aimed to assess the impact of individual comorbid conditions as well as the weight assignment, predictive properties and discriminating power of the Charlson Comorbidity Index (CCI) on outcome in patients with acute coronary syndrome (ACS). Methods A prospective multicentre observational study (AMIS Plus Registry) from 69 Swiss hospitals with 29 620 ACS patients enrolled from 2002 to 2012. The main outcome measures were in-hospital and 1-year follow-up mortality. Results Of the patients, 27% were female (age 72.1 ±12.6 years) and 73% were male (64.2±12.9 years). 46.8% had comorbidities and they were less likely to receive guideline-recommended drug therapy and reperfusion. Heart failure (adjusted OR 1.88; 95% CI 1.57 to 2.25), metastatic tumours (OR 2.25; 95% CI 1.60 to 3.19), renal diseases (OR 1.84; 95% CI 1.60 to 2.11) and diabetes (OR 1.35; 95% CI 1.19 to 1.54) were strong predictors of in-hospital mortality. In this population, CCI weighted the history of prior myocardial infarction higher (1 instead of -0.4, 95% CI -1.2 to 0.3 points) but heart failure (1 instead of 3.7, 95% CI 2.6 to 4.7) and renal disease (2 instead of 3.5, 95% CI 2.7 to 4.4) lower than the benchmark, where all comorbidities, age and gender were used as predictors. However, the model with CCI and age has an identical discrimination to this benchmark (areas under the receiver operating characteristic curves were both 0.76). Conclusions Comorbidities greatly influenced clinical presentation, therapies received and the outcome of patients admitted with ACS. Heart failure, diabetes, renal disease or metastatic tumours had a major impact on mortality. CCI seems to be an appropriate prognostic indicator for in-hospital and 1-year outcomes in ACS patients. ClinicalTrials.gov Identifier NCT01305785.
Osullivan C.J.,Stadtspital Triemli |
Wenaweser P.,University of Bern
Expert Review of Cardiovascular Therapy | Year: 2015
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of high-risk or inoperable patients presenting with symptomatic severe aortic stenosis (AS). There are several factors to consider to optimize patient outcomes from TAVI. Before TAVI, patient selection is key and an understanding the effects of common comorbidities on outcomes after TAVI is critical. Some comorbidities share common risk factors with AS (e.g. coronary artery disease), others are directly or indirectly caused or exacerbated by severe AS (e.g. atrial fibrillation, pulmonary hypertension, mitral regurgitation, tricuspid regurgitation and right ventricular dysfunction), whereas others are not directly related to severe AS (e.g. chronic kidney disease and chronic lung disease). Choice of transcatheter heart valve prosthesis, vascular access route and mode of anesthesia are important considerations during TAVI. New onset conduction disturbances and arrhythmias remain a vexing issue after TAVI. The aim of the present review is to provide an overview of these issues. © 2015 Taylor & Francis.
Meier P.,University of Bern |
Meier P.,University of Michigan |
Gloekler S.,University of Bern |
De Marchi S.F.,University of Bern |
And 3 more authors.
European Heart Journal | Year: 2010
AimsThe coronary collateral circulation has a beneficial role regarding all-cause and cardiac mortality. Hitherto, the underlying mechanism has not been clarified. The aim of this prospective study was to assess the effect of the coronary collateral circulation on electrocardiogram (ECG) QTc time change during short-term myocardial ischaemia.Methods and resultsA total of 150 patients (mean age 63 ± 11 years, 38 women) were prospectively included in this study. An ECG was recorded at baseline and during a standardized 1 min coronary balloon occlusion. QT interval was measured before, during, and after balloon occlusion and was corrected for heart rate (QTc). Simultaneously obtained collateral flow index (CFI), expressing collateral flow relative to normal anterograde flow, was determined based on intracoronary pressure measurements. During occlusion of the left anterior descending coronary artery mean QTc interval increased from 422 ± 33 to 439 ± 36 ms (P < 0.001), left circumflex occlusion led to an increase from 414 ± 32 to 427 ± 27 ms (P < 0.001). QTc was not influenced by occlusion of the right coronary artery (RCA) (417 ± 35 and 415 ± 34 ms, respectively; P = 0.863). QTc change during occlusion of the left coronary artery was inversely correlated with CFI (R2 = 0.122, P = 0.0002). Conclusion Myocardial ischaemia leads to QT prolongation during a controlled 1 min occlusion of the left, but not the RCA. QT prolongation is inversely related to collateral function indicating a protective mechanism of human coronary collaterals against cardiac death. © 2009 The Author.
Minder E.I.,Stadtspital Triemli |
Schneider-Yin X.,Stadtspital Triemli |
Minder C.E.,University of Zürich
Health and Quality of Life Outcomes | Year: 2010
Background: Protoporphyria (PP) resulting from two rare, inherited diseases of heme biosynthesis leads to dermal phototoxicity by accumulation of the heme precursor protoporphyrin IX. No standardized tools to quantify the degree of PP-related phototoxicity and its change by medical intervention have been published.Methods: Results from a questionnaire completed by 17 affected individuals were used to determine the relative importance of two main components of PP-related phototoxicity, skin pain and sunlight exposure time, with respect to the effectiveness of any particular medical treatment.Results: Inter-rater reliability was 0.71 (n = 490), repeated estimates by four identical individuals showed high reproducibility (Slope = 1, intercept = 0, n = 136, Passing-Bablock).Six different models were developed, three of them showed good correlation with effectiveness estimates. Data from an unpublished trial indicated that the model with highest potential of responsiveness was the so called "Exposure times [multiplied by] Freedom from Pain" (ETFP). The minimal clinically important difference (MID) was 15 (10.2-20.4) ETFP scores, representing 28% of the standard deviation of the clinical trial data and 2.9% of its total range.Conclusions: Among the six models proposed to assess the effectiveness of therapeutic interventions in PP the ETFP model demonstrates the highest sensitivity using the existing data from a clinical trial of afamelanotide in PP. The results of this study have provided sufficient validation of the ETFP model that is likely to prove useful in future clinical trials. © 2010 Minder et al; licensee BioMed Central Ltd.
Vavricka S.R.,Stadtspital Triemli |
Rogler G.,University of Zürich
Digestive Diseases | Year: 2012
Vitamins are micronutrient chemical compounds that cannot be synthesized by an organism but are essential for human metabolism and life. They act as required intermediaries, cofactors or coenzymes in many of the reactions of normal metabolism. In addition, anti-inflammatory effects have been reported for specific vitamins. In inflammatory bowel disease (IBD), vitamin deficiency is often due to malnutrition (due to a decreased food intake) or malabsorption (due to inflamed, malfunctioning mucosa and diarrhea) which results in anemia. Vitamin B12 and folic acid supplementation may be necessary in IBD patients, especially those with Crohn's disease (CD) with either inflammation of the terminal ileum or after resection of the terminal ileum. It is also recommended during therapy with sulfasalazine as this compound inhibits the absorption of vitamin B12. Patients with high or continuous inflammatory CD activity and frequent therapy with steroids have an increased risk of low bone mineral density and vitamin D deficiency. These should be monitored regularly and vitamin D should be supplemented. In a recent trial, a trend towards a reduced risk of relapses in CD patients treated with vitamin D was reported. Only limited studies and case reports exist on other vitamin deficiencies, e.g. vitamins A, B1, B2, niacine, B 6, C, E and K, found in IBD patients. These are summarized in this review. Regular nutritional monitoring in IBD patients is warranted and requires the special attention of treating physicians and dieticians. Copyright © 2012 S. Karger AG, Basel.
Treglia G.,Oncology Institute of Southern Switzerland |
Ceriani L.,Oncology Institute of Southern Switzerland |
Sadeghi R.,Mashhad University of Medical Sciences |
Giovacchini G.,Stadtspital Triemli |
Giovanella L.,Oncology Institute of Southern Switzerland
Clinical Chemistry and Laboratory Medicine | Year: 2014
Background: The aim of the article was to systematically review published data about the relationship between prostate-specific antigen (PSA) kinetics, including PSA doubling time (PSAdt) and PSA velocity (PSAvel), and detection rate (DR) of positron emission tomography/computed tomography (PET/CT) using radiolabelled choline in restaging prostate cancer (PCa). Methods: A comprehensive literature search of studies published through July 2013 regarding the relationship between PSA kinetics and DR of radiolabelled choline PET/CT was carried out. Furthermore, a meta-analysis was performed in order to establish the DR of radiolabelled choline PET/CT using different cut-off values of PSAdt (≤ or >6 months) and PSAvel [>1 or ≤1 ng/(mL year) and >2 or ≤2 ng/(mL year)]. Moreover, a pooled analysis to establish whether PSAdt and PSAvel (using the abovementioned cut-off values) may predict positive PET/CT results was carried out. Results: Fourteen articles were selected. The pooled DR of radiolabelled choline PET/CT in restaging PCa was 58% [95% confidence interval (CI) 55-60]. Most articles reported a relationship between PSA kinetics and DR of PET/CT. Pooled DR of radiolabelled choline PET/CT increased to 65% (95% CI 58-71) when PSAdt was ≤6 months and to 71% (95% CI 66-76) and 77% (95% CI 71-82) when PSAvel was >1 or >2 ng/(mL year), respectively. PSAdt ≤6 months and PSAvel >1 or >2 ng/(mL year) proved to be relevant factors in predicting the positive result of radiolabelled choline PET/CT. Conclusions: Due to the strong relationship between PSA kinetics and DR of radiolabelled choline PET/CT, beyond PSA values, PSAdt and PSAvel should be taken into account in the selection of PCa patients who should undergo radiolabelled choline PET/CT for restaging. © 2014 by Walter de Gruyter Berlin/Boston.
Richner S.,Stadtspital Triemli |
Laifer G.,Stadtspital Triemli
Swiss Medical Weekly | Year: 2010
Although unexplained lymphadenopathies are not particular prevalent in the general population (<1%), they represent a diagnostic dilemma. The differential diagnosis is broad, and although only few diseases will be either severe or treatable, patients as well as their doctors are in fear of missing a relevant diagnosis such as a malignancy. For the differential diagnosis it is prudent to distinguish between localised and generalised lymphadenopathy. Seventy-five percent of all lymphadenopathies are localised and often caused by a specific pathology in the area of drainage, which can be diagnosed without additional investigations. If the diagnosis is unclear, the patient is clinically stable and there is no suspicion of malignancy, it is safe to wait for three to four weeks and observe the clinical course. Exceptions are supraand infraclavicular lymph nodes, which are always suspicious of an underlying malignancy. Twenty-five percent of lymphadenopathies are generalised and are often a sign of a significant underlying disease. A diagnosis of lymphoma, malignancy, HIV infection or tuberculosis should not be missed. Excisional biopsy is regarded as the diagnostic method of choice, since it allows an assessment of the architecture of the lymph node as well as histological, immunohistochemical, cytogenetic and molecular investigations.
Genoni M.,Stadtspital Triemli |
Odavic D.,Stadtspital Triemli |
Loblein H.,Stadtspital Triemli |
Dzemali O.,Stadtspital Triemli
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery | Year: 2013
OBJECTIVE: The aim of this study was to assess early graft patency in eSVS Mesh-covered saphenous vein grafts (SVGs) in patients undergoing coronary artery bypass grafting. METHODS: In 20 patients meeting criteria for double arterial grafting to the left-sided coronary system and eSVS Mesh-covered SVG to the right-sided coronary system, patency was evaluated intraoperatively by transit time flow measurement and at 5 days postoperatively by computed tomographic angiography. RESULTS: Twenty patients underwent 49 arterial and 22 venous grafts (mean, 3.55/patient) using off-pump techniques. All grafts were determined to be patent intraoperatively. On computed tomographic angiography, arterial graft patency was 100%. In one venous anastomosis, the distal limb of a sequential graft was occluded, for an overall patency rate of 95%. CONCLUSIONS: The eSVS Mesh does not compromise early SVG patency. © 2013 by the International Society for Minimally Invasive Cardiothoracic Surgery.
Studer Bruengger A.A.,Stadtspital Triemli |
Kaufmann B.A.,University of Basel |
Buser M.,University of Basel |
Hoffmann M.,Stadtspital Triemli |
And 2 more authors.
Journal of the American Society of Echocardiography | Year: 2014
Background The response of diastolic Doppler indices to exercise is not well defined for young subjects. The aims of this study were to evaluate this in nonathletic and endurance-trained probands and to correlate echocardiographic data with maximal oxygen consumption.Methods In this prospective study, Doppler echocardiography was performed at rest and after exercise in 40 nonathletes (NAs) and 20 endurance-trained athletes (ETs) aged < 40 years, matched for age and gender. Diastolic function was assessed by mitral inflow and early diastolic velocities of the septal (e′ septal) and lateral (e′ lateral) mitral annulus. Maximal oxygen consumption quantification was performed simultaneously.Results All cardiac chambers were larger in ETs than NAs. ETs had higher e′ lateral at rest (18.1 ± 2.7 vs 16.3 ± 3.3 cm/sec, P =.02) and higher mitral E (141 ± 15 vs 132 ± 15 cm/sec, P =.02) and e′ lateral (23.5 ± 2.5 vs 21.4 ± 3.0 cm/sec, P =.01) with exercise than NAs. There was a slight increase in E/e′ septal (overall, from 6.8 ± 1.3 to 7.2 ± 1.2; P =.02) and E/e′ lateral (overall, from 5.0 ± 0.8 to 6.2 ± 0.9; P <.0001) with exercise. Changes in diastolic parameters with exercise were similar in ETs and NAs. Percentage of predicted maximal oxygen consumption was correlated with exertional E (r = 0.28, P =.03) and e′ lateral (r = 0.32, P =.01), but the strongest predictor was indexed left ventricular end-diastolic volume (r = 0.66, P <.0001).Conclusions During exercise, E/e′ increases but remains within normal ranges in healthy young subjects, and the response to exercise does not differ between ETs and NAs. These data help define the normal diastolic stress echocardiographic response in the young. Exercise capacity shows a correlation with enhanced exertional early diastolic velocities but is more closely related to cardiac structural adaption to endurance training. © 2014 by the American Society of Echocardiography.