First wave of the influenza A/H1N1v pandemic in Switzerland

AIM: To describe the disease burden, clinical pattern and outcome of influenza-related cases presenting to a Swiss Emergency Department (ED), during the first wave of the 2009 pandemic. METHODS: Retrospective analysis of prospectively collected data at the University Hospital of Basel, Switzerland. All patients presenting to the ED with influenza-like symptoms from June 1 to October 23, 2009, were studied. Rate of hospitalisation, demographic characteristics, symptoms, microbiological diagnoses and complications of influenza infection were analysed. RESULTS: One tenth (808 of 8356 patients) of all non-trauma ED presentations, during the study period, were a result of suspected influenza-related illness. Influenza A/H1N1v infection accounted for 5% of these presentations. Patients aged 50 years or less accounted for 87% of these presentations and for 100% of A/H1N1v infection. The highest detection rate of A/H1N1v-infection occurred in July, and the highest rate of clinical presentations occurred in August 2009. Underlying medical disease was observed in 14% of all patients. The presence of fever, cough and myalgia was the prime clinical predictor for the presence of A/H1N1v infection. 16% of patients with this triad suffered from A/H1N1v. CONCLUSION: Suspected A/H1N1v infection contributed to a considerable health care burden in Switzerland. However, the rate of true positivity was low (5%), hospitalisations rare (5%), and mortality did not occur. Therefore, the first wave of the A/H1N1v pandemic in Switzerland was rather media "hype" than real threat

Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement

PurposeFluoroscopic systems in modern interventional suites have the ability to perform flat panel detector CT (FDCT) with navigational guidance. Fusion with MR allows navigational guidance towards FDCT occult targets. We aim to evaluate the accuracy of this system using single-pass needle placement in a deep brain stimulation (DBS) phantom.Materials and methodsMR was performed on a head phantom with DBS lead targets. The head phantom was placed into fixation and FDCT was performed. FDCT and MR datasets were automatically fused using the integrated guidance system (iGuide, Siemens). A DBS target was selected on the MR dataset. A 10 cm, 19 G needle was advanced by hand in a single pass using laser crosshair guidance. Radial error was visually assessed against measurement markers on the target and by a second FDCT. Ten needles were placed using CT-MR fusion and 10 needles were placed without MR fusion, with targeting based solely on FDCT and fusion steps repeated for every pass.ResultsMean radial error was 2.75±1.39 mm as defined by visual assessment to the centre of the DBS target and 2.80±1.43 mm as defined by FDCT to the centre of the selected target point. There were no statistically significant differences in error between MR fusion and non-MR guided series.ConclusionsSingle pass needle placement in a DBS phantom using FDCT guidance is associated with a radial error of approximately 2.5-3.0 mm at a depth of approximately 80 mm. This system could accurately target sub-centimetre intracranial lesions defined on MR

Diagnose angeborener Störungen der Thrombozytenfunktion Interdisziplinäre S2K-Leitlinie der Ständigen Kommission Pädiatrie der Gesellschaft für Thrombose- und Hämostaseforschung e. V.

Congenital disorders of platelet function are a heterogeneous group of disorders that are often not detected until bleeding occurs. In clinical settings only a few methods have proven to be useful for identification and classification of inherited platelet disorders. For a rational diagnostic approach, a stepwise algorithm is recommended. Patient history and clinical investigation are mandatory. Von Willebrand disease and other coagulation disorders should always be ruled out prior to specific platelet testing. Platelet count, size, volume (MPV) and morphology may guide further investigations. The PFA-100® CT is suited for screening for severe platelet defects. Platelet aggregometry allows assessment of multiple aspects of platelet function. Flow cytometry enables diagnosis of thrombasthenia Glanzmann, Bernard-Soulier syndrome and storage pool defects. Molecular genetics may confirm a putative diagnosis or pave the way for identifying new defects. We present an unabridged version of the interdisciplinary guideline

Therapie hereditärer Thrombozytopathien. Interdisziplinäre S2K-Leitlinie der Ständigen Kommission Pädiatrie der Gesellschaft für Thrombose- und Hämostaseforschung e. V.

Inherited disorders of platelet function are a heterogeneous group. For optimal prevention and management of bleeding, classification and diagnosis of the underlying defect are highly recommended. An interdisciplinary guideline for a diagnostic approach has been published (AWMF # 086-003 S2K; Hämostaseologie 2014; 34: 201-212). Underlying platelet disorder, platelet count, age and clinical situation modify treatment. Exclusive transfusion of platelet concentrates may be inappropriate as potentially adverse effects can outweigh its benefit. A stepwise and individually adjusted approach for restitution and maintenance of haemostasis is recommended. Administration of antifibrinolytics is generally endorsed, but is of particular use in Quebec disease. Restricted to older children, desmopressin is favourable in storage pool disease and unclassified platelet disorders. Although licensed only for patients with Glanzmann thrombasthenia and alloantibodies, in clinical practice rFVIIa is widely used in inherited platelet disorders with severe bleeding tendency. This guideline aims at presenting the best available advice for the management of patients with inherited platelet function disorders

Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement

PURPOSE: Fluoroscopic systems in modern interventional suites have the ability to perform flat panel detector CT (FDCT) with navigational guidance. Fusion with MR allows navigational guidance towards FDCT occult targets. We aim to evaluate the accuracy of this system using single-pass needle placement in a deep brain stimulation (DBS) phantom. MATERIALS AND METHODS: MR was performed on a head phantom with DBS lead targets. The head phantom was placed into fixation and FDCT was performed. FDCT and MR data sets were automatically fused using the integrated guidance system (iGuide, Siemens). A DBS target was selected on the MR data set. A 10cm, 19G needle was advanced by hand in a single pass using laser crosshair guidance. Radial error was visually assessed against measurement markers on the target and by a second FDCT. 10 needles were placed using CT-MR fusion and 10 needles were placed without MR fusion, targeting based solely off of the FDCT, with fusion steps repeated for every pass. RESULTS: Mean radial error was 2.75±1.39 mm as defined by visual assessment to the center of the DBS target and 2.80±1.43 mm as defined by FDCT to the center of the selected target point. There were no statistically significant differences in error between MR fusion and non-MR guided series. CONCLUSIONS: Single pass needle placement in a DBS phantom using FDCT guidance is associated with a radial error of approximately 2.5–3.0 mm at a depth of approximately 80 mm. This system could accurately target sub-centimeter intracranial lesions defined on MR

The genetics of familial combined hyperlipidaemia.

Item does not contain fulltextAlmost 40 years after the first description of familial combined hyperlipidaemia (FCHL) as a discrete entity, the genetic and metabolic basis of this prevalent disease has yet to be fully unveiled. In general, two strategies have been applied to elucidate its complex genetic background, the candidate-gene and the linkage approach, which have yielded an extensive list of genes associated with FCHL or its related traits, with a variable degree of scientific evidence. Some genes influence the FCHL phenotype in many pedigrees, whereas others are responsible for the affected state in only one kindred, thereby adding to the genetic and phenotypic heterogeneity of FCHL. This Review outlines the individual genes that have been described in FCHL and how these genes can be incorporated into the current concept of metabolic pathways resulting in FCHL: adipose tissue dysfunction, hepatic fat accumulation and overproduction, disturbed metabolism and delayed clearance of apolipoprotein-B-containing particles. Genes that affect metabolism and clearance of plasma lipoprotein particles have been most thoroughly studied. The adoption of new traits, in addition to the classic plasma lipid traits, could aid in the identification of new genes implicated in other pathways in FCHL. Moreover, systems genetic analysis, which integrates genetic polymorphisms with data on gene expression levels, lipidomics or metabolomics, will attribute functions to genetic variants in addition to revealing new genes.1 juni 201