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Beat Frauchiger Chefarzt i.R./ Senior Consultant Facharzt für Innere Medizin und Angiologie Amselweg 3 CH-8500 Frauenfeld beat.frauchiger[at]stgag.ch Dr. med. ...doi:10.4414/saez.2020.19406 fatcat:tdlx6ad6cjah7ickav3gdfnau4
Beat Frauchiger Chefarzt i.R./ Senior Consultant Facharzt für Innere Medizin und Angiologie Amselweg 3 CH-8500 Frauenfeld beat.frauchiger[at]stgag.ch Dr. med. ...doi:10.4414/bms.2020.19406 fatcat:aytw776sujeevfjjcusc2qxo5q
Abklärung und Behandlung der PAV K: Aspekte der Spitalmedizin Beat Frauchiger a , Joachim Lehn a , Alexander von Weymarn b , Cristoforo Medugno c , Beat Bundi a a Angiologie, Medizinische Klinik, Kantonsspital ... Beat Frauchiger Die Autoren haben keine finanzielle Unterstützung und keine Interessenkonflikte im Zusammenhang mit diesem Beitrag deklariert. ...doi:10.4414/smf.2013.01692 fatcat:wspfv3qqffbx7ix25vj3spon7i
Hintergrund Das Mammakarzinom ist das häufigste Malignom der Frau, typische Metastasierungsorte sind Knochen, Lunge, Leber, Hirn, Weichteile und Nebennieren. Wir präsentieren hier den Fall einer ungewöhnlichen Metastasierung in den Gastrointestinaltrakt eines sechs Jahre zuvor diagnostizierten Mammakarzinoms.doi:10.4414/smf.2019.08300 fatcat:rg3e2pwaf5cytdn74jpnb66isi
doi:10.1177/014107680009300108 pmid:10700843 pmcid:PMC1288048 fatcat:opyedrgdlzc23igdmdvedim7fi
Contexte Le cancer du sein est la tumeur maligne la plus fréquente chez la femme, les sites de métastatisation typiques étant les os, les poumons, le foie, le cerveau, les tissus mous et les glandes surrénales. Nous présentons ici un cas de métastatisation inhabituelle dans le tractus gastro-intestinal (GI) d'un cancer du sein diagnostiqué six ans auparavant.doi:10.4414/fms.2019.08300 fatcat:ngtab6tm7nezhp6qoxkqsdchs4
IMT measurements in the ICA have a massive scatter. 30 IMT CCA measurements are easier to obtain, are more reliable ,and have been proved in many studies. 3,31,32 Frauchiger et al Carotid Resistive ...doi:10.1161/01.str.32.4.836 pmid:11283379 fatcat:5g6zod7cjnfcrenn7u67xpatka
A systolic blood pressure <100 mm Hg was present in 31 (8%), oxygen saturation in room air <90% in 116/330 (35%), and heart rate ≥110 beats/min in 113/358 (32%). ... A low sPESI was defined as an age ≤80 years and absence of systemic hypotension (systolic pressure <100 mm Hg), tachycardia (heart rate ≥110 beats per minute), hypoxia (oxygen saturation <90%), cancer, ...doi:10.1160/th11-06-0371 pmid:21833454 fatcat:oc44u55oifczjb5ofw725gzjha
1− minimal diastolic velocity peak systolic velocity Pulse and blood pressure behaviour Since all the pulse measurements were between 52 and 90 As was expected, the systolic blood pressure in group beats ...doi:10.1093/ndt/15.6.827 pmid:10831635 fatcat:mxhi7k2knzaazex6jjam3ht5gu
SummaryIn patients with acute cancer-associated thrombosis, current consensus guidelines recommend anticoagulation therapy for an indefinite duration or until the cancer is resolved. Among 1,247 patients with acute venous thromboembolism (VTE) enrolled in the prospective Swiss Venous Thromboembolism Registry (SWIVTER) II from 18 hospitals, 315 (25%) had cancer of whom 179 (57%) had metastatic disease, 159 (50%) ongoing or recent chemotherapy, 83 (26%) prior cancer surgery, and 63 (20%)doi:10.1160/th11-01-0002 pmid:21475778 fatcat:mpikid5r5vggpmpvakgzs5mewq
more »... VTE. Long-term anticoagulation treatment for >12 months was more often planned in patients with versus without cancer (47% vs. 19%; p<0.001), with recurrent cancer-associated versus first cancer-associated VTE (70% vs. 41%; p<0.001), and with metastatic versus non-metastatic cancer (59% vs. 31%; p<0.001). In patients with cancer, recurrent VTE (OR 3.46; 95%CI 1.83–6.53), metastatic disease (OR 3.04; 95%CI 1.86–4.97), and the absence of an acute infection (OR 3.55; 95%CI 1.65–7.65) were independently associated with the intention to maintain anticoagulation for >12 months. In conclusion, long-term anticoagulation treatment for more than 12 months was planned in less than half of the cancer patients with acute VTE. The low rates of long-term anticoagulation in cancer patients with a first episode of VTE and in patients with non-metastatic cancer require particular attention.
SummaryThere is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohortdoi:10.1160/th13-05-0427 pmid:24226257 fatcat:zor2xa6rd5a7xfvad2dd6glkga
more »... 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2–4.6%) in 962 high-risk vs 0.6% (95% CI 0.2–1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3–5.3%) in 714 high-risk vs 1.1% (95% CI 0.6–2.3%) in 764 lowrisk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10–0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28–0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.
Improved thromboprophylaxis for acutely ill medical patients relies on valid predictions of thrombotic risks. Our aim was to compare the performance of the Improve and Geneva clinical risk assessment models (RAMs), and to simplify the current Geneva RAM. Methods Medical inpatients from eight Swiss hospitals were prospectively followed during 90 days, for symptomatic venous thromboembolism (VTE) or VTE-related death. We compared discriminative performance and calibration of the RAMs, usingdoi:10.1160/th17-06-0403 pmid:29304528 fatcat:sdfbm7umyfhjnheg67tptzkizu
more »... o-event methods with competing risk modelling of non-VTE death. Results In 1,478 patients, the 90-day VTE cumulative incidence was 1.6%. Discrimination of the Improve and Geneva RAM was similar, with a 30-day AUC (areas under the curve) of 0.78 (95% CI [confidence interval]: 0.65–0.92) and 0.81 (0.73–0.89), respectively. According to the Improve RAM, 68% of participants were at low risk (0.8% VTE at 90 days), and 32% were at high risk (4.7% VTE), with a sensitivity of 73%. According to the Geneva RAM, 35% were at low risk (0.6% VTE) and 65% were at high risk (2.8% VTE), with a sensitivity of 90%. Among patients without thromboprophylaxis, the sensitivity was numerically greater in the Geneva RAM (85%) than in the Improve RAM (54%). We derived a simplified Geneva RAM with comparable discrimination and calibration as the original Geneva RAM. Conclusions We found comparably good discrimination of the Improve and Geneva RAMs. The Improve RAM classified more patients as low risk, but with possibly lower sensitivity and greater VTE risks, suggesting that a lower threshold for low risk (<2) should be used. The simplified Geneva RAM may represent an alternative to the Geneva RAM with enhanced usability.
The evidence on the prognostic value of transthoracic echocardiography (TTE) in elderly, hemodynamically stable patients with pulmonary embolism (PE) is limited. Objectives: To evaluate the prevalence of common echocardiographic signs of right ventricular (RV) dysfunction and their prognostic impact in hemodynamically stable patients aged ≥65 years with acute PE in a prospective multicenter cohort. Methods: TTE was performed by cardiologists. We defined RV dysfunction as a RV/left ventriculardoi:10.1016/j.thromres.2016.07.014 pmid:27498122 fatcat:nif6j5phqjagfnjcpbl3uqnawu
more »... tio >0.9 or RV hypokinesis (primary definition) or the presence of ≥1 or ≥2 of 6 predefined echocardiographic signs (secondary definitions). Outcomes were overall mortality and mortality/non-fatal recurrent venous thromboembolism (VTE) at 30 days, adjusting for the Pulmonary Embolism Severity Index risk score and highly sensitive troponin T values. Results: Of 400 patients, 36% had RV dysfunction based on our primary definition, and 81% (≥1 sign) and 53% (≥2 signs) based on our secondary definitions, respectively. Using our primary definition, there was no association between RV dysfunction and mortality (adjusted HR 0.90, 95% CI 0.31-2.58) and mortality/nonfatal VTE (adjusted HR 1.09, 95% CI 0.40-2.98). Similarly, there was no statistically significant association between the presence of ≥1 or ≥2 echocardiographic signs (secondary definitions) and clinical outcomes. Conclusion: The prevalence of echocardiographic RV dysfunction varied widely depending upon the definition used. There was no association between RV dysfunction and clinical outcomes. Thus, TTE may not be suitable as a stand-alone risk assessment tool in elderly patients with acute PE. 4 Clinical Trial Registration: http://clinicaltrials.gov. Identifier: NCT00973596.
We aimed to assess whether elderly patients with acute venous thromboembolism (VTE) receive recommended initial processes of care and to identify predictors of process adherence. Methods: We prospectively studied in-and outpatients aged $65 years with acute symptomatic VTE in a multicenter cohort study from nine Swiss university-and non-university hospitals between September 2009 and March 2011. We systematically assessed whether initial processes of care, which are recommended by the 2008doi:10.1371/journal.pone.0100164 pmid:24983634 pmcid:PMC4077699 fatcat:kahkkkjplbaxvizkmy3neg6uvm
more »... can College of Chest Physicians guidelines, were performed in each patient. We used multivariable logistic models to identify patient factors independently associated with process adherence. Results: Our cohort comprised 950 patients (mean age 76 years). Of these, 86% (645/750) received parenteral anticoagulation for $5 days, 54% (405/750) had oral anticoagulation started on the first treatment day, and 37% (274/750) had an international normalized ratio (INR) $2 for $24 hours before parenteral anticoagulation was discontinued. Overall, 35% (53/153) of patients with cancer received low-molecular-weight heparin monotherapy and 72% (304/423) of patients with symptomatic deep vein thrombosis were prescribed compression stockings. In multivariate analyses, symptomatic pulmonary embolism, hospital-acquired VTE, and concomitant antiplatelet therapy were associated with a significantly lower anticoagulation-related process adherence. Conclusions: Adherence to several recommended processes of care was suboptimal in elderly patients with VTE. Quality of care interventions should particularly focus on processes with low adherence, such as the prescription of continued lowmolecular-weight heparin therapy in patients with cancer and the achievement of an INR $2 for $24 hours before parenteral anticoagulants are stopped. Citation: Stuck AK, Méan M, Limacher A, Righini M, Jaeger K, et al. (2014) The Adherence to Initial Processes of Care in Elderly Patients with Acute Venous Thromboembolism. PLoS ONE 9(7): e100164.
Little is known about predictors and outcomes of recurrent venous thromboembolism in elderly patients. Methods: We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was symptomatic recurrent venous thromboembolism. We explored the association between baseline characteristics and treatments and recurrent venous thromboembolism using competing risk regression, adjusting for periods of anticoagulation asdoi:10.1016/j.amjmed.2017.12.015 pmid:29307536 fatcat:gzxw4wpsfbbcdac7ojb7dd46fy
more »... a time-varying co-variate. We also assessed the clinical consequences (case-fatality, localization) of recurrent venous thromboembolism. Results : During a median follow-up period of 30 months, 122 patients developed recurrent venous thromboembolism, corresponding to a 3-year cumulative incidence of 14.8%. The case-fatality of recurrence was high (20.5%), particularly in patients with unprovoked (23%) and cancer-related venous thromboembolism (29%). After adjustment, only unprovoked venous thromboembolism (sub-hazard ratio [SHR] 1.67 compared to provoked venous thromboembolism; 95% confidence interval [CI] 1.00-2.77) and proximal deep vein thrombosis (SHR 2.41 compared to isolated distal deep vein thrombosis; 95% CI 1.07-5.38) were significantly associated with recurrence. Patients with initial pulmonary embolism were more likely to have another pulmonary embolism as a recurrent event than patients with deep vein thrombosis. Conclusions: Elderly patients with acute venous thromboembolism have a substantial long-term risk of recurrent venous thromboembolism and recurrence carries a high case-fatality rate. Only two factors, unprovoked venous thromboembolism and proximal deep vein thrombosis, were independently associated with recurrent venous thromboembolism, indicating that traditional risk
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