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Naoussa, Greece

Audet M.,University of Strasbourg | Piardi T.,University of Strasbourg | Panaro F.,University of Strasbourg | Cag M.,University of Strasbourg | And 5 more authors.
Clinical Transplantation | Year: 2010

Introduction: The advanced age of the recipient is considered a " relative contraindication" to liver transplantation (LT). However, recently some studies reported a morbidity rate and an overall survival comparable with those of younger patients. Here, we reported the outcome after LT in recipients aged >65 yr. Methods: Between January 2000 and December 2006, 565 LT was performed in 502 recipients in our institution. Of these, 34 were recipients of >65 yr old (aged group). We focused our study comparing: donor age, co-morbidities, model for end-stage liver disease (MELD) and American Society of Anesthesiologists (ASA) score, duration of operation, transfusions and outcome between the two groups (young/aged). Results: For the group aged >65: the mean donor age was 52.5 (range 16-75) yr and the graft weight 1339 g (890-1880 g). Co-morbidity was recorded in 25 (73.5%), coronary artery disease (CAD) in 17 (50%), diabetes mellitus (DM) and chronic renal insufficiency in four (11.7%) and chronic obstructive pulmonary disease (COPD) in three patients (8.8%). Mean MELD score was 14.9 (range 12-29) and ASA score was two in 15 (44.1%); and three in 19 (55.8%) recipients. Mean operation time was four h 45 min, three patients also received combined kidney transplantation. Twenty-five (73.5%) recipients received blood transfusions (mean 3.2). Morbidity was observed in 20 patients (58.8%); of these two had hepatic artery thrombosis requiring re-LT. Overall survival was 80% (40 months of follow-up), in particularly, at 30-d, one yr, three yr was 91%, 84%, 80%, respectively. The only two statistical differences reported (p = 0.02) are: the lower rate of CAD in the younger group of recipients (12%), compared with the aged group (50%) and the subsequently lower mortality rate secondary to cardiac causes in the younger group (1.4%) compared with aged group (8.8%). Conclusion: Our results suggest that the recipient age should not be considered an absolute contraindication for LT when the graft/recipient matching is optimal and when an adequate cardiac assessment is performed. © 2009 John Wiley & Sons A/S.

Eichler K.,University of Zurich | Hess S.,University of Zurich | Riguzzi M.,University of Zurich | Can U.,Surgical Clinic | Brugger U.,University of Zurich
Swiss Medical Weekly | Year: 2015

QUESTIONS UNDER STUDY: Evidence-based recommendations play an important role in medical decisionmaking, but barriers to adherence are common. In Switzerland, the Swiss Medical Board (SMB) publishes evidence reports that conclude with recommendations. We assessed the impact of two SMB reports on service provision (2009: Recommendation of conservative treatment as first option for rupture of the anterior cruciate ligament of the knee; 2011: Recommendation against PSA screening for prostate cancer). METHODS: We performed an observational study and assessed quantitative data over time via interrupted times series analyses. The primary outcome was the quarterly number of performed prostate-specific antigen (PSA) tests and the annual rates of surgical ACL repair in patients with ACL rupture. Data were adjusted for time trends and relevant confounders. RESULTS: We analysed PSA tests in 662,874 outpatients from 2005-2013 and treatment data in 101,737 patients with knee injury from 1990-2011. For the number of PSA tests, the secular trend before the intervention showed a continuous but diminishing increase over time. A statistically significant reduction in tests was estimated immediately after the intervention, but a later return to the trend before the intervention cannot be ruled out. The rate of surgical ACL repair had already declined after the late 1990s to about 55% in 2009. No relevant additional change emerged in this secular trend after the intervention. CONCLUSIONS: Despite some evidence of a possible change, we did not find a sustained and significant impact of SMB recommendations in our case study. Further monitoring is needed to confirm or refute these findings.

Bock S.,Cantonal Hospital St. Gallen | Wolff K.,Cantonal Hospital St. Gallen | Marti L.,Cantonal Hospital St. Gallen | Schmied B.M.,Cantonal Hospital St. Gallen | Hetzer F.H.,Surgical Clinic
Diseases of the Colon and Rectum | Year: 2013

Background: Stapled transanal rectal resection with a new, curved, multifire stapler (Transtar procedure) has shown promising short- and midterm results for treating obstructed defecation syndrome. However, few results have been published on long-term outcome. Objective: This study aimed to investigate long-term functional results and quality of life after the Transtar procedure. Design: This is a retrospective study. Setting: This study was conducted at a tertiary hospital in Switzerland. Patients: Seventy consecutive Patients (68 female) with obstructed defecation syndrome had a median age of 65 years (range, 20-90). INTERVENTION: The Transtar procedure was performed between January 2007 and March 2010. Main Outcome Measures: Postoperative functional results were evaluated with the Symptom Severity Score, Obstructed Defecation Score, and Cleveland Incontinence Score. Quality of life was evaluated with the Fecal Incontinence Quality of Life Score and the SF-36 Health Survey. Data were divided into 4 groups of 1-, 2-, 3-, and 4-year follow-ups. Results: The functional scores showed significant postoperative improvement throughout the studied period (p = 0.01). The quality-of-life scores showed a tendency for improvement only in the mental components on the SF-36 Health Survey (p = 0.01). Sixteen Patients reported postoperative fecal urgency, but this subsided within a few months. Nine Patients reported new postoperative episodes of incontinence and required further treatment. Limitations: This study was limited by its retrospective nature, the selection bias, and a bias by the small number of questionnaires available for some scores. Conclusion: The Transtar procedure was successful for long-term treatment of obstructed defecation syndrome. Fecal urgency and incontinence were observed, but typically resolved within months. Therefore, the Transtar procedure appears to be a reasonable approach to treating obstructed defecation syndrome in the long term. © The ASCRS 2013.

David K.A.,Indivumed GmbH | Unger F.T.,Indivumed GmbH | Uhlig P.,Indivumed GmbH | Juhl H.,Indivumed GmbH | And 6 more authors.
Oncotarget | Year: 2014

An understanding of tissue data variability in relation to processing techniques during and postsurgery would be desirable when testing surgical specimens for clinical diagnostics, drug development, or identification of predictive biomarkers. Specimens of normal and colorectal cancer (CRC) tissues removed during colon and liver resection surgery were obtained at the beginning of surgery and postsurgically, tissue was fixed at 10, 20, and 45 minutes. Specimens were analyzed from 50 patients with primary CRC and 43 with intrahepatic metastasis of CRC using a whole genome gene expression array. Additionally, we focused on the epidermal growth factor receptor pathway and quantified proteins and their phosphorylation status in relation to tissue processing timepoints. Gene and protein expression data obtained from colorectal and liver specimens were influenced by tissue handling during surgery and by postsurgical processing time. To obtain reliable expression data, tissue processing for research and diagnostic purposes needs to be highly standardized.

Farhi D.,Dermatology Clinic | Trevidic P.,Surgica1 Clinic | Kestemont C.P.,SurgicJ Clinic | Boineau D.,Deriiiatology Clinic | And 5 more authors.
Journal of Drugs in Dermatology | Year: 2013

Background: Emervel consists of a range of 5 hyaluronic acid (HA) fillers (Touch, Classic, Lips, Deep, and Volume), with a fixed HA concentration (20 mg/mL), and various degrees of cross-linking and calibration. Objectives: To describe the current use of Emervel fillers in France. Methods: Prospective multicenter, cross-sectional, real-practice, descriptive survey, including 1,822 patients injected with Emervel fillers for face rejuvenation by 58 French physicians between September 2010 and July 2011. The injection modalities were left to the respective physician's discretion. Results: The physicians were dermatologists (52.3%), surgeons (43.8%), or general practitioners (14.1%). Nasolabial folds (NLF) with a mean severity 2.4 were mainly injected with Emervel Deep (51.0%) and Emervel Classic (36.0%) (mean volume: 1.0 mL), and primarily with the linear retrograde (LR) technique (89.3%). Marionette lines (ML), with a mean severity 2.6 were mainly injected with Emervel Deep (52.5%) and Emervel Classic (34.6%) (mean volume: 0.8 mL), and mainly with the LR technique (79.5%). More than 90% of patients had scores of 0 or 1 for erythema, bruising, edema, and pain. No serious adverse events were reported up to 15 months after the injection. Conclusion: These data could contribute to upcoming international consensus on optimal injection modalities of the Emervel range of HA fillers.

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