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Zürich, Switzerland

Aneurysms and dissections of the thoracic and abdominal aorta are the most common diseases of the aortic tree and are associated with a high morbidity and mortality caused by bleeding in case of rupture or malperfusion of vital organs in case of dissection. The knowledge of epidemiology, pathophysiology and clinical presentation allows the most appropriate diagnostic evaluation in both acute and chronic situations. Ultrasound is the ideal and most cost-effective imaging modality for screening and follow-up investigations of abdominal aortic aneurysms. Contrast-enhanced computed tomography is the most appropriate imaging for aneurysm of the thoracic aorta or for acute events with rupture or dissection. Source

Mueller-Pfeiffer C.,Universitats Spital Zurich | Mueller-Pfeiffer C.,Massachusetts General Hospital
Schweizer Archiv fur Neurologie und Psychiatrie

The most frequent traumatic experiences in Switzerland are accidents and violent acts with a lifetime prevalence of 5 and 2%, respectively. Approximately 15% of survivors develop a posttraumatic stress disorder (PTSD) in the aftermath of the traumatic event. PTSD is often accompanied with functional impairment. Consequently, PTSD plays a major role in insurance medicine. Forensic assessments often induce substantial stress in PTSD clients because the forensic setting may trigger traumatic feelings of fear and helplessness. Reliability of PTSD diagnosis and working capacity among evaluators are often insufficient. Here, we provide strategies for establishing a safe forensic relationship with traumatised clients. We propose a systematic approach to evaluating psychopathology, functional impairment and working capacity. We also address potential novel procedures such as a psychophysiological diagnostic laboratory test and limitations that need to be overcome in order to improve reliability and validity in forensic PTSD assessment. Source

Goede J.S.,Universitats Spital Zurich
Therapeutische Umschau

Asplenia is found in a very heterogeneous group of patients with a wide range of age and comorbidities. These patients have an increased risk of overwhelming post-splenectomy infections (OPSI) even several decades after splenectomy. The mortality rate associated with OPSI is 30-60 %, which is why the immunisation against encapsulated bacteria is mandatory. In addition these patients show an increased risk of thrombosis of the portal venous system. In the present article all the necessary, during daily practice often neglected preventsive measures and behavioural rules are discussed. © 2013 Verlag Hans Huber, Hogrefe AG, Bern. Source

Haslinger C.,Universitats Spital Zurich | Gonser M.,Klinik fur Geburtshilfe und Pranatalmedizin

Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disease. It occurs in the second half of pregnancy and is characterized by sometimes intensive, nocturnally increased maternal pruritus and raised maternal serum bile acid levels. The ICP has a good prognosis for the mother with usually rapid recovery after delivery but is associated with adverse fetal outcomes, such as preterm delivery, intrapartum fetal distress, meconium contamination of the amniotic fluid and stillbirth, particularly near term. Ursodeoxycholic acid (UDCA) is considered to be the first-line treatment for ICP and was shown to reduce maternal pruritus and to lower maternal serum bile acid levels. Stillbirth due to ICP is a consequence of acute anoxia and not due to chronic uteroplacental insufficiency. As a consequence the usual methods of fetal monitoring, such as ultrasound or cardiotocography (CTG), cannot be used to predict an adverse perinatal outcome. For this reason, early induction of labor after 37 weeks of gestation, also depending on serum bile acid levels, is recommended by many authors. © 2015, Springer-Verlag Berlin Heidelberg. Source

Straumann D.,Universitats Spital Zurich
Schweizer Archiv fur Neurologie und Psychiatrie

The successful road to neuro-otology starts with an appreciation of phenomenology, in particular eye movements. Some physiological facts and "laws"concerning the vestibulo-ocular reflex (VOR) constitute the basis for accurate neuro-otological diagnosis. These include the frequency-dependence of the VOR, the concept of vestibular resting rate, the push-pull configuration of the semicircular canals, Ewald's second law, Alexander's law, and the inherent imbalance of vertical eye position. Only when one is able to distinguish normal from disordered ocular motor behaviour, and understands the underlying physiological mechanisms, is it possible to identify the affected neuro anatomical structures and establish accurate diagnoses. Source

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