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Sankt Gallen, Switzerland

Bosch M.M.,University of Zurich | Barthelmes D.,University of Zurich | Merz T.M.,University of Bern | Knecht P.B.,University of Zurich | And 8 more authors.
Archives of Ophthalmology

Objective: To investigate the effect of very high altitude and different ascent profiles on central corneal thickness (CCT). Methods: Twenty-eight healthy mountaineers were randomly assigned to 2 different ascent profiles during a medical research expedition to Mount Muztagh Ata (7546 m) in western China. Group 1 was allotted a shorter acclimatization time prior to ascent to 6265 m. The main outcome measure was CCT. Secondary outcome measures were oxygen saturation (SpO2) and symptom assessments of acute mountain sickness (cerebral acute mountain sickness score). Examinations were performed at 490, 4497, 5533, and 6265 m. Results: Central corneal thickness increased in both groups with increasing altitude and decreased after descent. In group 1 (with the shorter acclimatization), mean CCT increased from 537 to 572 μ m. Mean CCT in group 2 increased from 534 to 563 μ m (P=.048). The amount of decrease in SpO2 paralleled the increase in CCT. There was no significant decrease in visual acuity. There was a significant correlation between CCT and cerebral acute mountain sickness score when controlled for SpO2 and age. Conclusions: Corneal swelling during high-altitude climbs is promoted by low SpO2. Systemic delivery of oxygen to the anterior chamber seems to play a greater role in corneal oxygenation than previously thought. Adhering to a slower ascent profile results in less corneal edema. Visual acuity in healthy corneas is not adversely affected by edema at altitudes of up to 6300 m. Individuals with more acute mountain sickness-related symptoms had thicker corneas, possibly due to their higher overall susceptibility to hypoxia. ©2010 American Medical Association. All rights reserved. Source

Gautschi O.P.,State Hospital St. Gallen | Gautschi O.P.,University of Western Australia | Stienen M.N.,Ruhr University Bochum | Hermann C.,State Hospital St. Gallen | And 3 more authors.
Acta Neurochirurgica

Background: In the current climate of increasing awareness, patients are demanding more knowledge about forthcoming operations. The patient information accounts for a considerable part of the physician's daily clinical routine. Unfortunately, only a small percentage of the information is understood by the patient after solely verbal elucidation. To optimise information delivery, different auxiliary materials are used. Methods: In a prospective study, 52 consecutive stationary patients, scheduled for an elective lumbar disc operation were asked to use a web-based audiovisual patient information system. A combination of pictures, text, tone and video about the planned surgical intervention is installed on a tablet personal computer presented the day before surgery. All patients were asked to complete a questionnaire. Results: Eighty-four percent of all participants found that the audiovisual patient information system lead to a better understanding of the forthcoming operation. Eighty-two percent found that the information system was a very helpful preparation before the pre-surgical interview with the surgeon. Ninety percent of all participants considered it meaningful to provide this kind of preoperative education also to patients planned to undergo other surgical interventions. Eighty-four percent were altogether "very content" with the audiovisual patient information system and 86% would recommend the system to others. Conclusions: This new approach of patient information had a positive impact on patient education as is evident from high satisfaction scores. Because patient satisfaction with the informed consent process and understanding of the presented information improved substantially, the audiovisual patient information system clearly benefits both surgeons and patients. © 2010 Springer-Verlag. Source

Hildebrandt G.,State Hospital St. Gallen | Brandle M.,State Hospital St. Gallen | Stienen M.N.,State Hospital St. Gallen | Gautschi O.P.,State Hospital St. Gallen | Van Leyen K.,State Hospital St. Gallen
Chirurgia (Turin)

Surgery of tumours in the region of the 3rd ventricle belongs to the most challenging tasks of the neurosurgeon. Postoperative endocrine disorders account for severe morbidity with heavy impact on the patient's life. It was our intention to focus on endocrinologic issues associated with surgery of 3rd ventricle tumours and the vicinity of the hypothalamus. All cases of tumour resection of the 3rd ventricle via the translaminar approach between 01/2007 and 01/2010 were considered. Neurologic, neuroradiologic, endocrinologic and ophthalmologic parameters were analyzed in order to find parameters being positively or negatively associated with diabetes insipidus and postoperative obesity. Furthermore, a review of the current knowledge on hypothalamic control of food-intake and energy metabolism is provided. Three cases with a mean age of 24.0 years and mean preoperative body mass index (BMI) of 23.3kg/m 2 were identified. Histopathological diagnoses were craniopharyngeoma, pilocytic astrocytoma and germinoma. A mean follow-up of 27.06 months was conducted. Postoperative severe obesity occurred in all three patients with a mean BMI of 33.2kg/m2 after six months. Mean serum prolactin levels were 30.3μg/l pre- and 60.6μg/l three months postoperatively. Obesity correlated with hypothalamic damage in the postoperative MRI and high serum prolactin levels. Conclusion. Obesity and diabetes insipidus centralis as consequences of surgery occurred in all patients operated via the translaminar route. A massive increase in body weight was observed, which proved hard to be influenced through dietary means alone. Further research is needed to ameliorate quality of life in those patients with good prognosis. Source

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