CT Coronary Angiography Versus Conventional Invasive Coronary Angiography - The View of the Referring Physician [CT-Koronarangiografie versus konventionelle invasive Koronarangiografie - Die Sicht der Zuweiser]
Maurer M.H.,Universitatsspital Bern
Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren | Year: 2014
Purpose: Assessment of experience gained by local referring physicians with the procedure of coronary computed tomographic angiography (CCTA) in the everyday clinical routine. Materials and Methods: A 25-item questionnaire was sent to 179 physicians, who together had referred a total of 1986 patients for CCTA. They were asked about their experience to date with CCTA, the indications for coronary imaging, and their practice in referring patients for noninvasive CCTA or invasive catheter angiography. Results: 53 questionnaires (30 %) were assessable, corresponding to more than 72 % of the patients referred. Of the referring physicians who responded, 94 % saw a concrete advantage of CCTA in the treatment of patients, whereby 87 % were 'satisfied' or 'very satisfied' with the reporting. For excluding coronary heart disease (CHD) where there was a low pre-test probability of disease, the physicians considered CCTA to be superior to conventional coronary diagnosis (4.2 on a scale of 1 - 5) and vice versa for acute coronary syndrome (1.6 of 5). The main reasons for unsuitability of CCTA for CT diagnosis were claustrophobia and the absence of a sinus rhythm. The level of exposure to radiation in CCTA was estimated correctly by only 42 % of the referring physicians. 90 % of the physicians reported that their patients evaluated their coronary CT overall as 'positive' or 'neutral', while 87 % of the physicians whose patients had undergone both procedures reported that the patients had experienced CCTA as the less disagreeable of the two. Conclusion: CCTA is accepted by the referring physicians as an alternative imaging procedure for the exclusion of CHD and received a predominantly positive assessment from both the referring physicians and the patients. Key points: • A high percentage of referring physicians had positive experiences with noninvasive CT coronary angiography (CCTA) so far. • CCTA is accepted by referring physicians as an alternative imaging procedure for the exclusion of coronary heart disease. • Noninvasive CT coronary angiography is perceived by patients in direct comparison with conventional invasive coronary angiography as less disagreeable. Citation Format: • Maurer MH, Zimmermann E, Hamm B et al. CT Coronary Angiography Versus Conventional Invasive Coronary Angiography - The View of the Referring Physician. Fortschr Röntgenstr 2014; DOI: 10.1055/s-0034-1366432 © Georg Thieme Verlag KG.
Clement N.,Universitatsspital Bern
Swiss medical weekly : official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology | Year: 2010
To assess the relationship between nationality, gender and age and use of health services among patients visiting an urban university hospital emergency department (ED). ED crowding is an increasingly significant national and international problem. Overcrowding has many potential detrimental effects, including frustration for patients and ED personnel and greater risk of poor outcomes. This is partially caused by the growing numbers of visits by so called "walk-in patients" with minor problems. From May 1, 2007 to May 31, 2008, sociodemographic information was collected prospectively from 6955 male and 4303 female patients at Inselspital, University Hospital Bern, Switzerland, who had requested our emergency services for non-urgent problems. A stratified sample of 1173 patients was taken for further analysis of referral by a general practitioner (GP) and having a GP at all. In all, 26% of visits were by foreign nationals. Only 57% of these were registered with a GP, compared to 83% of Swiss nationals (p <0.0001). Swiss patients referred themselves to us in 87%, compared to 97% self-referrals among foreigners (p <0.0001). Between 7:00 pm and 7:00 am, our ED was significantly more often visited by non-Swiss patients (p <0.0001). Foreign patients were significantly younger than Swiss patients (median age 45, range 1-98 years versus age 35, range 2-89 years, p <0.0001). Nationality is associated with greater use of ED services for non-urgent problems. Several explanations are conceivable for this. Clinical and policy efforts must address barriers to GP care, since in the long term the GP provides better and more cost-effective care for patients with minor complaints.
Verra M.L.,Universitatsspital Bern
Therapeutische Umschau | Year: 2011
In this review the therapeutical options of physiotherapy in patients with chronic musculoskeletal pain, especially non-specific back pain, are reported. The importance of the objective "reduction of pain related disability of individual activities of daily living" is reported. Various methods of exercise therapy and their application in either a monodisciplinary setting or in an interdisciplinary pain management team are discussed. © 2011 by Verlag Hans Huber, Hogrefe AG, Bern.
Tutuian R.,Universitatsspital Bern
Therapeutische Umschau | Year: 2013
Obesity and gastro-esophageal reflux disease (GERD) are two of the major health problems of the industrialized world. Both condition have increasing prevalence, pathophysiologic and endoscopic studies identified obesity a major risk factor in the development of GERD. Conversely, successful weight reduction improves GERD symptoms and diminishes the use of acid suppressive medications. Bariatric interventions are not all equal when it comes to controlling GERD symptoms, lesions and use of medication. Gastric banding has a variable influence on GERD, while most patients report improved reflux symptoms, up to 20 % of patient can develop "de novo" reflux symptoms following gastric banding. Gastric sleeve resection increases reflux symptoms, in particular in patients with an ideal, tubular gastroplasty and those with proximal (fundic) pouch. Roux-en-Y gastric bypass has a positive effect of GERD, reducing symptoms and use of acid suppressive medications. From an esophageal perspective, gastric bypass is the preferred bariatric procedure to treat and prevent GERD in morbidly obese patients. © 2013 Verlag Hans Huber, Hogrefe AG, Bern.
Ullrich F.,ETH Zurich |
Bergeles C.,ETH Zurich |
Bergeles C.,Harvard University |
Pokki J.,ETH Zurich |
And 7 more authors.
Investigative Ophthalmology and Visual Science | Year: 2013
PURPOSE. To investigate microrobots as an assistive tool for minimally invasive intraocular surgery and to demonstrate mobility and controllability inside the living rabbit eye. METHODS. A system for wireless magnetic control of untethered microrobots was developed. Mobility and controllability of a microrobot are examined in different media, specifically vitreous, balanced salt solution (BSS), and silicone oil. This is demonstrated through ex vivo and in vivo animal experiments. RESULTS. The developed electromagnetic system enables precise control of magnetic microrobots over a workspace that covers the posterior eye segment. The system allows for rotation and translation of the microrobot in different media (vitreous, BSS, silicone oil) inside the eye. CONCLUSIONS. Intravitreal introduction of untethered mobile microrobots can enable sutureless and precise ophthalmic procedures. Ex vivo and in vivo experiments demonstrate that microrobots can be manipulated inside the eye. Potential applications are targeted drug delivery for maculopathies such as AMD, intravenous deployment of anticoagulation agents for retinal vein occlusion (RVO), and mechanical applications, such as manipulation of epiretinal membrane peeling (ERM). The technology has the potential to reduce the invasiveness of ophthalmic surgery and assist in the treatment of a variety of ophthalmic diseases. ©2013 The Association for Research in Vision and Ophthalmology, Inc.
The effect of stress-relieving interventions on inflammatory bowel disease: Quality assessment of 10 therapeutic studies [Der effekt stressreduzierender interventionen auf chronisch entzündliche darmerkrankungen: qualitätskontrolle von zehn therapeutischen studien]
Camara R.J.A.,Universitatsspital Bern |
Begre S.,Universitatsspital Bern |
Von Kanel R.,Universitatsspital Bern
Zeitschrift fur Psychosomatische Medizin und Psychotherapie | Year: 2010
Objectives: Patient comments and empirical studies suggest an influence of stress on inflammatory bowel diseases (IBD). We performed a quality assessment of previous studies on the effect of stress reduction on IBD in order to formulate recommendations for future studies and to evaluate their potential for improvement. Methods: Studies were searched for in the PubMed online library and in the bibliographies of the located sources. Based on an analysis of the study design and the methodology of individual studies, we made specific recommendations following recognized methodological principles and used them to evaluate the analyzed studies. Results: The 10 studies identified differed in terms of exclusion criteria, distribution of characteristics, stress reduction, and effect measurements. The recommendations formulated had not been followed exhaustively in these studies. Conclusions: Computation of sample size to detect relevant effects, orientation toward previous studies, documentation of potential confounders, and confidence intervals are criteria that are easy to consider and well-known, and that, if applied to future studies, might enhance the quality of IBD research. © 2010 Vandenhoeck & Ruprecht GmbH & Co. KG.
Feller-Heppt G.,Skin and Face Clinic |
Haneke E.,Universitatsspital Bern |
Heppt M.V.,Ludwig Maximilians University of Munich
Facial Plastic Surgery | Year: 2014
Abstract Fillers are frequently used in beautifying procedures. Despite major advancements of the chemical and biological features of injected materials, filler-related adverse events may occur, and can substantially impact the clinical outcome. Filler granulomas become manifest as visible grains, nodules, or papules around the site of the primary injection. Early recognition and proper treatment of filler-related complications is important because effective treatment options are available. In this report, we provide a comprehensive overview of the differential diagnosis and diagnostics and develop an algorithm of successful therapy regimens. Copyright © 2014 by Thieme Medical Publishers, Inc.
Haneke E.,Universitatsspital Bern
Facial Plastic Surgery | Year: 2014
Injectable fillers nowadays represent a pillar in facial rejuvenation and make a significant contribution to the success of the treatment. Despite their obvious benefits, a wide range of possible complications such as immediate, late, delayed, temporary, or irreversible adverse effects have to be respected. Differentiating the various filler materials, these effects are assigned to histopathology findings and currently available treatment options. © 2014 by Thieme Medical Publishers, Inc.
Moalli F.,University of Bern |
Proulx S.T.,ETH Zurich |
Schwendener R.,University of Zürich |
Detmar M.,ETH Zurich |
And 2 more authors.
Frontiers in Immunology | Year: 2015
Aberrant antigens expressed by tumor cells, such as in melanoma, are often associated with humoral immune responses, which may in turn influence tumor progression. Despite recent data showing the central role of adaptive immune responses on cancer spread or control, it remains poorly understood where and how tumor-derived antigen (TDA) induces a humoral immune response in tumor-bearing hosts. Based on our observation of TDA accumulation in B cell areas of lymph nodes (LNs) from melanoma patients, we developed a pre-metastatic B16.F10 melanoma model expressing a fluorescent fusion protein, tandem dimer tomato, as a surrogate TDA. Using intravital two-photon microscopy (2PM) and whole-mount 3D LN imaging of tumor-draining LNs in immunocompetent mice, we report an unexpectedly widespread accumulation of TDA on follicular dendritic cells (FDCs), which were dynamically scanned by circulating B cells. Furthermore, 2PM imaging identified macrophages located in the subcapsular sinus of tumor-draining LNs to capture subcellular TDA-containing particles arriving in afferent lymph. As a consequence, depletion of macrophages or genetic ablation of B cells and FDCs resulted in dramatically reduced TDA capture in tumor-draining LNs. In sum, we identified a major pathway for the induction of humoral responses in a melanoma model, which may be exploitable to manipulate anti-TDA antibody production during cancer immunotherapy. © 2015 Moalli, Proulx, Schwendener, Detmar, Schlapbach and Stein.
Luder G.,Universitatsspital Bern
Sportverletzung Sportschaden : Organ der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin | Year: 2011
Surgical hip dislocation (SHD) is a common procedure to treat several hip problems, namely femoroacetabular impingements. After surgery patients are required to walk with reduced weight-bearing for six to eight weeks. The literature describes important changes in general health and functional state after immobilization but little is known about physical and functional recovery of these deficits. The aim of the study was to investigate the conditional deficits and changes of patients 3 and 12 months after SHD, and to compare them to healthy subjects. A prospective cross-sectional study with three groups was performed: 29 patients 3 months after SHD (G3), 28 patients 12 months after SHD (G12) and 34 healthy persons (G0). Strength, endurance, gait, stair climbing and balance were measured and self-perceived performance and satisfaction with daily-life activities was evaluated with questionnaires. Group differences were tested with Kruskal-Wallis test and post-hoc with the Mann-Whitney U test. Significant differences were found for G3 compared to G0 in strength and endurance parameters, as well as for gait and self-perceived performance. G12 also showed significant differences compared to G0 and only little differences were found compared to G3. The remaining deficits in patients twelve month after SHD with regard to conditional and functional parameters indicate that full recovery for activities of daily life has not been achieved by these patients. A specific therapy program may be able to improve the patient's strength, endurance and functional performance and may possibly lead to effective protection of the joint and enhanced performance in daily life.