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Zürich, Switzerland

Osullivan C.J.,Stadtspital Triemli | Wenaweser P.,University of Bern
Expert Review of Cardiovascular Therapy

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. Source

Giovacchini G.,Stadtspital Triemli | Breeuwsma A.J.,University of Groningen
Quarterly Journal of Nuclear Medicine and Molecular Imaging

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. Source

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

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. Source

Vavricka S.R.,Stadtspital Triemli | Rogler G.,University of Zurich
Digestive Diseases

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. Source

Radovanovic D.,University of Zurich | Seifert B.,University of Zurich | Eberli F.R.,Stadtspital Triemli | Rickli H.,Kantonsspital St. Gallen | And 3 more authors.

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. Source

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