Nottwil, Switzerland
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Gustot T.,Free University of Colombia | Felleiter P.,Swiss Paraplegic Center Nottwil | Pickkers P.,Radboud University Nijmegen | Sakr Y.,Friedrich - Schiller University of Jena | And 7 more authors.
Liver International | Year: 2014

Background: Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. Aims: We used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II 1-day point-prevalence study to better define the characteristics of infection in these patients. Methods: We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. Results: The EPIC II database includes 13 796 adult patients from 1265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, P < 0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, P < 0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, P < 0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (P < 0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, P < 0.05). Conclusions: Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly caused by Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients. © 2014 John Wiley & Sons A/S.


Kratzsch T.,Kantonsspital St Gallen | Kratzsch T.,Charité - Medical University of Berlin | Stienen M.N.,Kantonsspital St Gallen | Stienen M.N.,Hopitaux Universitaires Of Geneva | And 4 more authors.
Pain Physician | Year: 2015

Background: Intrathecal (IT) drug therapy with implanted pumps is an effective treatmentmodality for chronic pain and/or spasticity, especially after non-invasive treatment has failed.Long-term use of intrathecal opioids may cause formation of inflammatory masses at the tip ofintrathecal catheters, possibly leading to neurological deficits and/or catheter revision.Objective: We aimed to identify risk factors for catheter-tip granuloma (CG) formation.Study Design: Retrospective study.Setting: Tertiary Spine Centers in Germany and SwitzerlandMethods: We retrospectively reviewed data at 2 Swiss centers (Kantonsspital St. Gallen, SwissParaplegic Centre Nottwil) between 01/1994 and 10/2013. Collected data were age at operation,gender, smoking status, previous spinal operations, spinal level of catheter-tip, clinical symptoms,catheter testing with contrast agent, applied drugs, drug concentration, as well as cumulative dailydrug dosages.Results: Thirteen patients with a mean age of 52.6 years and CG formation after a mean of6.9 years of follow-up were identified and compared to 54 patients of similar age and length offollow-up (48.6 years, P = 0.535; follow-up 5.3 years, P = 0.236) without CG. In the analysis of riskfactors, catheter ending in the middle thoracic spine (Th4-8; 38.5 vs. 6.5%; P = 0.010), previousspinal surgery (75 vs. 41%; P = 0.051), and chronic pain as an underlying primary symptom for ITdrug therapy (100 vs. 56%, P = 0.003) were associated with CG formation. IT drug therapy forspasticity appeared to be much less associated with CG formation (0 vs. 44%, P = .0003). As thesymptomatology is closely related to the medical treatment applied, patients with CG were morelikely to be treated with IT morphine (77 vs. 20%; P < 0.001), and as tendency with IT clonidine(54 vs. 26%; P = 0.092) and IT bupivacaine (46 vs. 20%; P = 0.077). Average in-pump morphineconcentration (30.3 vs. 19.5 mg/mL; P = 0.05) as well as average daily dose of morphine (12.5 vs.6.2 mg/d; P = 0.037) were significantly higher in the CG group. Smoking could not be identifiedas risk factor for CG formation.Limitations: Limitations include the retrospective approach, the limited group size of granulomapatients, as well as missing data in the investigated patient groups.Conclusion: Our patient cohort with CG differed in some features, of which some like catheterlocalization, choice, dosage, and the concentration of drugs are potentially modifiable. Theseresults could contribute to the prevention of CG in the future. © 2015, American Society of Interventional Pain Physicians. All rights reserved.


Kerr J.,Swiss Paraplegic Center Nottwil | Borbas P.,University of Zürich | Meyer D.C.,University of Zürich | Gerber C.,University of Zürich | And 2 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2015

Background: In wheelchair-dependent individuals, pain often develops because of rotator cuff tendon failure and/or osteoarthritis of the glenohumeral joint. The purposes of this study were to investigate (1) specific rotator cuff tear patterns, (2) structural healing, and (3) clinical outcomes after arthroscopic rotator cuff repair in a cohort of wheelchair-dependent patients. Methods: Forty-six shoulders with a mean follow-up of 46 months (range, 24-82 months; SD, 13 months) from a consecutive series of 61 shoulders in 56 patients (46 men and 10 women) undergoing arthroscopic rotator cuff repair were available for analysis. Clinical outcome analysis was performed using the Constant-Murley score, the Subjective Shoulder Value, and the American Shoulder and Elbow Surgeons score. The integrity of the repair was analyzed by ultrasound. Results: Of the shoulders, 87% had supraspinatus involvement, 70% had subscapularis involvement, and 57% had an anterosuperior lesion involving both the supraspinatus and subscapularis. Despite an overall structural failure rate of 33%, the patients showed improvements in the Constant-Murley score from 50 points (range, 22-86 points; SD, 16 points) preoperatively to 80 points (range, 40-98 points; SD, 12 points) postoperatively and in the American Shoulder and Elbow Surgeons score from 56 points (range, 20-92 points; SD, 20 points) preoperatively to 92 points (range, 53-100 points; SD, 10 points) postoperatively, with a mean postoperative Subjective Shoulder Value of 84% (range, 25%-100%; SD, 17%). Conclusion: Failure of the rotator cuff in weight-bearing shoulders occurs primarily anterosuperiorly. Arthroscopic rotator cuff repair leads to a structural failure rate of 33% but satisfactory functional results with high patient satisfaction at midterm follow-up. © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.


Wettstein R.,University of Basel | Savic M.,University of Basel | Pierer G.,University of Basel | Scheufler O.,University of Basel | And 6 more authors.
Stem Cell Research and Therapy | Year: 2014

Introduction. Chronic wounds are a major health-care issue, but research is limited by the complexity and heterogeneity in terms of wound etiology as well as patient-related factors. A suitable animal model that replicates the situation in humans is not available. Therefore, the aim of the present work is to present a standardized human wound model and the data of a pilot study of topically applied progenitor cells in a sacral pressure sore. Methods. Three patients underwent cell harvest from the iliac crest at the time of the initial debridement. Forty-eight hours after bone marrow harvest and debridement, the CD34§ssup§+§esup§ selected cell suspension was injected into the wound. With the aid of a laser scanner, three-dimensional analyses of wound morphometry were performed until the defect was reconstructed with a local flap 3 weeks after debridement. Results: Decreases in volume to 60% ± 6% of baseline on the sham side and to 52% ± 3% of baseline on the cell side were measured. Histologic work-up revealed no signs of metaplastic, dysplastic, or neoplastic proliferation/differentiation after progenitor cell treatment. CD34§ssup§+§esup§ cells were detected in the biopsies of day 0. Conclusions: The pressure sore wound model allows investigation of the initial 3 weeks after cell-based therapy. Objective outcome analysis in terms of wound volume and histology can be performed without, or with, minimal additional morbidity, and the anatomy of the sacral area allows a control and study side in the same patient. Therefore, this model can serve as a standard for wound-healing studies. Trial registration. ClinicalTrials.gov NCT00535548. © 2014 Wettstein et al.; licensee BioMed Central Ltd.


Diel P.,University of Bern | Reuss W.,University of Bern | Aghayev E.,University of Bern | Moulin P.,Swiss Paraplegic Center Nottwil | Roder C.,University of Bern
Spine Journal | Year: 2010

Background context: The Swiss Federal Office of Public Health demanded a nationwide health technology assessment registry for cervical and lumbar total disc arthroplasty and for balloon kyphoplasty (BKP) to make a decision about reimbursement of these interventions. Purpose: The goal of the SWISSspine registry is to generate evidence about the safety and effectiveness of these technologies. We report on results of patients with balloon kyphoplasty. Study design/setting: Prospective, multicenter, observational case series. Patient sample: From March 2005 until June 2008, 331 interventions with 391 treated levels in 320 patients have been documented. 75.6% of patients were females with mean age of 74 years (range 43-95.2 years); mean age of males was 72.6 years (range 41.4-93 years). Outcome measures: Surgeon-administered outcome instruments were primary intervention form for BKP, implant, and follow-up form; patient self-reported measures were Euroqol-5D, North American Spine Society, and a comorbidity questionnaire. Methods: Data were recorded perioperative, at 3 months, 1 year, and annually thereafter. Wilcoxon signed-rank test was used for comparison of preoperative to postoperative measurements. Multivariate regression was used for identifying factors with a significant influence on the outcome. Results: Significant and clinically relevant reduction of back pain, improvement of quality of life (QoL), and reduction of pain killer consumption were seen in the 1-year follow-up. Improvement of preoperative segmental kyphosis was achieved in the majority of cases. There were three symptomatic cement extrusions with radiculopathy documented. Conclusions: Balloon kyphoplasty is a safe and effective treatment concerning pain reduction, QoL improvement, and pain killer consumption. The SWISSspine registry proved to be an excellent tool for evaluation of this new technology, and its results, in combination with an elaborate health technology assessment report, led to a permanent coverage of BKP by the basic health insurance. © 2010 Elsevier Inc. All rights reserved.


Bersch I.,Swiss Paraplegic Center Nottwil | Tesini S.,Swiss Paraplegic Center Nottwil | Bersch U.,Swiss Paraplegic Center Nottwil | Frotzler A.,Swiss Paraplegic Center Nottwil
Artificial Organs | Year: 2015

Functional electrical stimulation (FES) has clinical evidence in the rehabilitation of patients with spinal cord injury as indicated by several studies. Both inpatients and outpatients benefit from the therapeutic effect of the FES. The application areas are multifaceted and can be customized on the need for patients. This is represented by the individuality of the programmability of the stimulators and the variety of stimulation schedules that are based on the knowledge about the effects of FES on structural and functional level. Nevertheless, looking into daily clinical practice, the use of FES is rather poor. Expenditure of time, complexity of technical equipment, and compliance and acceptance of therapists and patients should be taken into account as limiting factors. © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.


Aghayev E.,University of Bern | Henning J.,University of Bern | Munting E.,Clinique Saint Pierre | Diel P.,University of Bern | And 2 more authors.
European Spine Journal | Year: 2012

Background: Comparative effectiveness research in spine surgery is still a rarity. In this study, pain alleviation and quality of life (QoL) improvement after lumbar total disc arthroplasty (TDA) and anterior lumbar interbody fusion (ALIF) were anonymously compared by surgeon and implant. Methods: A total of 534 monosegmental TDAs from the SWISSspine registry were analyzed. Mean age was 42 years (19-65 years), 59 % were females. Fifty cases with ALIF were documented in the international Spine Tango registry and used as concurrent comparator group for the pain analysis. Mean age was 46 years (21-69 years), 78 % were females. The average follow-up time in both samples was 1 year. Comparison of back/leg pain alleviation and QoL improvement was performed. Unadjusted and adjusted probabilities for achievement of minimum clinically relevant improvements of 18 VAS points or 0.25 EQ-5D points were calculated for each surgeon. Results: Mean preoperative back pain decreased from 69 to 30 points at 1 year (ØΔ 39pts) after TDA, and from 66 to 27 points after ALIF (ØΔ 39pts). Mean preoperative QoL improved from 0.34 to 0.74 points at 1 year (ØΔ 0.40pts). There were surgeons with better patient selection, indicated by lower adjusted probabilities reflecting worsening of outcomes if they had treated an average patient sample. ALIF had similar pain alleviation than TDA. Conclusions Pain alleviation after TDA and ALIF was similar. Differences in surgeon's patient selection based on pain and QoL were revealed. Some surgeons seem to miss the full therapeutic potential of TDA by selecting patients with lower symptom severity. © Springer-Verlag 2012.


Bersch I.,Swiss Paraplegic Center Nottwil | Frotzler A.,Swiss Paraplegic Center Nottwil | Baumberger M.,Swiss Paraplegic Center Nottwil
Biomedizinische Technik | Year: 2013

Functional electrical stimulation (FES) has clinical evidence in the rehabilitation of patients with spinal cord injury. Nevertheless, looking into daily clinical practice, the use of FES is poor. Expenditure of time, complexity of technical equipment and compliance and acceptance of therapists and patients should be discussed as limiting factors. © 2013 by Walter de Gruyter.


PubMed | Hopitaux Universitaires Of Geneva, Swiss Paraplegic Center Nottwil and Kantonsspital St. Gallen
Type: Journal Article | Journal: Pain physician | Year: 2015

Intrathecal (IT) drug therapy with implanted pumps is an effective treatment modality for chronic pain and/or spasticity, especially after non-invasive treatment has failed. Long-term use of intrathecal opioids may cause formation of inflammatory masses at the tip of intrathecal catheters, possibly leading to neurological deficits and/or catheter revision.We aimed to identify risk factors for catheter-tip granuloma (CG) formation.Retrospective study.Tertiary Spine Centers in Germany and Switzerland.We retrospectively reviewed data at 2 Swiss centers (Kantonsspital St. Gallen, Swiss Paraplegic Centre Nottwil) between 01/1994 and 10/2013. Collected data were age at operation, gender, smoking status, previous spinal operations, spinal level of catheter-tip, clinical symptoms, catheter testing with contrast agent, applied drugs, drug concentration, as well as cumulative daily drug dosages.Thirteen patients with a mean age of 52.6 years and CG formation after a mean of 6.9 years of follow-up were identified and compared to 54 patients of similar age and length of follow-up (48.6 years, P = 0.535; follow-up 5.3 years, P = 0.236) without CG. In the analysis of risk factors, catheter ending in the middle thoracic spine (Th4-8; 38.5 vs. 6.5%; P = 0.010), previous spinal surgery (75 vs. 41%; P = 0.051), and chronic pain as an underlying primary symptom for IT drug therapy (100 vs. 56%, P = 0.003) were associated with CG formation. IT drug therapy for spasticity appeared to be much less associated with CG formation (0 vs. 44%, P = .0003). As the symptomatology is closely related to the medical treatment applied, patients with CG were more likely to be treated with IT morphine (77 vs. 20%; P < 0.001), and as tendency with IT clonidine (54 vs. 26%; P = 0.092) and IT bupivacaine (46 vs. 20%; P = 0.077). Average in-pump morphine concentration (30.3 vs. 19.5 mg/mL; P = 0.05) as well as average daily dose of morphine (12.5 vs. 6.2 mg/d; P = 0.037) were significantly higher in the CG group. Smoking could not be identified as risk factor for CG formation.Limitations include the retrospective approach, the limited group size of granuloma patients, as well as missing data in the investigated patient groups.Our patient cohort with CG differed in some features, of which some like catheter localization, choice, dosage, and the concentration of drugs are potentially modifiable. These results could contribute to the prevention of CG in the future.


PubMed | Swiss Paraplegic Center Nottwil
Type: Journal Article | Journal: Artificial organs | Year: 2015

Functional electrical stimulation (FES) has clinical evidence in the rehabilitation of patients with spinal cord injury as indicated by several studies. Both inpatients and outpatients benefit from the therapeutic effect of the FES. The application areas are multifaceted and can be customized on the need for patients. This is represented by the individuality of the programmability of the stimulators and the variety of stimulation schedules that are based on the knowledge about the effects of FES on structural and functional level. Nevertheless, looking into daily clinical practice, the use of FES is rather poor. Expenditure of time, complexity of technical equipment, and compliance and acceptance of therapists and patients should be taken into account as limiting factors.

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