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Iudici M, Hemmig AK, Stegert M, Courvoisier C, Adler S, Becker MO, Berger CT, Dan D, Finckh A, Mahr A, Neumann T, Reichenbach S, Ribi C, Seitz L, Villiger P, Wildi L, Daikeler T. Management of giant-cell arteritis in Switzerland: an online national survey. Swiss Med Wkly 2023; 153:40051. [PMID: 37011593 DOI: 10.57187/smw.2023.40051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
AIMS OF THE STUDY To assess current practices in diagnosing, treating, and following-up giant-cell arteritis by specialists in Switzerland and to identify the main barriers to using diagnostic tools. METHODS We performed a national survey of specialists potentially caring for patients with giant-cell arteritis. The survey was sent by email to all members of the Swiss Societies of Rheumatology and for Allergy and Immunology. A reminder was sent to nonresponders after 4 and 12 weeks. Its questions covered the following dimensions: respondents' main characteristics, diagnosis, treatment, and imaging's role during follow-up. The main study results were summarized using descriptive statistics. RESULTS Ninety-one specialists, primarily aged 46-65 years (n = 53/89; 59%), working in academic or nonacademic hospitals or private practice, and treating a median of 7.5 (interquartile range [IQR]: 3-12) patients with giant-cell arteritis per year participated in this survey. Ultrasound of temporal arteries/large vessels (n = 75/90; 83%) and positron-emission-tomography-computed tomography (n = 52/91; 57%) or magnetic resonance imaging (n = 46/90; 51%) of the aorta/extracranial arteries were the most common techniques used to diagnose giant-cell arteritis with cranial or large vessel involvement, respectively. Most participants reported a short time to obtain imaging tests or arterial biopsy. The glucocorticoid tapering scheme, glucocorticoid-sparing agent, and glucocorticoid-sparing treatment duration varied among the participants. Most physicians did not follow a predefined repeat imaging scheme for follow-up and mainly relied on structural changes (vascular thickening, stenosis, or dilatation) to drive treatment choice. CONCLUSIONS This survey indicates that imaging and temporal biopsy are rapidly accessible for diagnosing giant-cell arteritis in Switzerland but highlights heterogeneous practice in many disease management areas.
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Affiliation(s)
- Michele Iudici
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Mihaela Stegert
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Courvoisier Courvoisier
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sabine Adler
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of Rheumatology, Immunology and Allergology, University Hospital, University of Bern, Bern, Switzerland
| | - Mike Oliver Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christoph T Berger
- University Center for Immunology, University Hospital Basel, Basel, Switzerland
- Department Biomedicine, Translational Immunology, University of Basel, Basel, Switzerland
| | - Diana Dan
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Axel Finckh
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Alfred Mahr
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Thomas Neumann
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Stephan Reichenbach
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Luca Seitz
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Peter Villiger
- Department of Rheumatology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Lukas Wildi
- Department of Rheumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Thomas Daikeler
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
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Sartoretti E, Sartoretti T, Schwenk Á, Alfieri A, Czell D, Wyss M, Wildi L, Binkert CA, Sartoretti-Schefer S. High-Resolution 3D versus Standard-Resolution 2D T2-Weighted Turbo Spin Echo MRI for the Assessment of Lumbar Nerve Root Compromise. Tomography 2022; 8:257-266. [PMID: 35202186 PMCID: PMC8880003 DOI: 10.3390/tomography8010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Radiculopathy can be caused by nerve root irritation and nerve root compression at the level of the lateral recess or at the level of the intervertebral foramen. T2-weighted (T2w) MRI is considered essential to evaluate the nerve root and its course, starting at the lateral recess through the intervertebral foramen to the extraforaminal space. With the introduction of novel MRI acceleration techniques such as compressed SENSE, standard-resolution 2D T2w turbo spin echo (TSE) sequences with a slice-thickness of 3–4 mm can be replaced with high-resolution isotropic 3D T2w TSE sequences with sub-millimeter resolution without prolonging scan time. With high-resolution 3D MRI, the course of the nerve root can be visualized more precisely due to a detailed depiction of the anatomical situation and less partial volume effects, potentially allowing for a better detection of nerve root compromise. In this intra-individual comparison study, 55 patients with symptomatic unilateral singular nerve root radiculopathy underwent MRI with both 2D standard- and 3D high-resolution T2w TSE MRI sequences. Two readers graded the degree of lumbar lateral recess stenosis and lumbar foraminal stenosis twice on both image sets using previously validated grading systems in an effort to quantify the inter-readout and inter-sequence agreement of scores. Inter-readout agreement was high for both grading systems and for 2D and 3D imaging (Kappa = 0.823–0.945). Inter-sequence agreement was moderate for both lumbar lateral recess stenosis (Kappa = 0.55–0.577) and lumbar foraminal stenosis (Kappa = 0.543–0.572). The percentage of high degree stenosis with nerve root deformity increased from 16.4%/9.8% to 41.8–43.6%/34.1% from 2D to 3D images for lateral recess stenosis/foraminal stenosis, respectively. Therefore, we show that while inter-readout agreement of grading systems is high for both standard- and high-resolution imaging, the latter outperforms standard-resolution imaging for the visualization of lumbar nerve root compromise.
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Affiliation(s)
- Elisabeth Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland; (E.S.); (Á.S.); (C.A.B.); (S.S.-S.)
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland;
| | - Thomas Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland; (E.S.); (Á.S.); (C.A.B.); (S.S.-S.)
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland;
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht University, 6211 LK Maastricht, The Netherlands
- Correspondence:
| | - Árpád Schwenk
- Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland; (E.S.); (Á.S.); (C.A.B.); (S.S.-S.)
| | - Alex Alfieri
- Institute of Neurosurgery, Kantonsspital Winterthur, 8401 Winterthur, Switzerland;
| | - David Czell
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland;
| | - Michael Wyss
- Philips Health Systems, 8810 Zürich, Switzerland;
| | - Lukas Wildi
- Institute of Rheumatology, Kantonsspital Winterthur, 8401 Winterthur, Switzerland;
| | - Christoph A. Binkert
- Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland; (E.S.); (Á.S.); (C.A.B.); (S.S.-S.)
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland;
| | - Sabine Sartoretti-Schefer
- Institute of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland; (E.S.); (Á.S.); (C.A.B.); (S.S.-S.)
- Faculty of Medicine, University of Zürich, 8006 Zürich, Switzerland;
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Berben L, Sigg N, Daly ML, Bachmann S, Baer W, Berthet G, Bolt I, Dan D, Enderlin Steiger S, Fröhlich J, Hasler P, Hofer M, Huemer C, Kaiser D, Marcoli N, Palmer Sarott S, Rottländer Y, Schmid G, Soennichsen C, Strahm Furler L, Vanoni F, Wildi L, Daikeler T, Woerner A. Current practice of transitional care for adolescents and young adults in Swiss paediatric and adult rheumatology centres. Swiss Med Wkly 2021; 151:w30046. [PMID: 34797619 DOI: 10.4414/smw.2021.w30046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND About half of all children with rheumatic diseases need continuous medical care during adolescence and adulthood. A good transition into adult rheumatology is essential. Guidelines for a structured transition process have therefore been recommended by the European League Against Rheumatism (EULAR) and the Paediatric Rheumatology European Society (PReS). However, implementation of these guidelines requires resources often not available in a busy clinical practice. AIMS To assess the current practice of transitional care in Switzerland in relation to EULAR/PReS recommendations and to describe gaps and challenges in following the recommendations. METHODS All paediatric Swiss rheumatology centres and their collaborating adult centres offering a transition service to adult care were invited to participate in this survey. The responsible paediatric and adult rheumatologist of each centre was interviewed separately using a structured manual addressing the EULAR/PReS transitional care recommendations. RESULTS All 10 paediatric and 9 out of 10 adult rheumatologists agreed to participate. Centres varied in the number of patients in transition, from n = 0 to n = 111. The following EULAR/PReS recommendations were implemented and applied in most centres: continuity in the healthcare team, consultations focused on adolescents and young adults, joint consultations between the paediatric and adult rheumatologist, and access to the EULAR website. Only rarely did a centre have a written transition policy or evaluate their transitional care programme. The vast majority of the interviewees had no specific training in adolescent health. Most centres rated their transitional care performance as very good. CONCLUSION Transition in Switzerland is not uniform and consequently the implementation of the EULAR/PReS recommendations is variable in Swiss rheumatology centres. Skills of healthcare professionals, continuity between clinical settings, size of the centres, and hospital focus on the needs of adolescents and young adults may represent key predictors of successful transitional care for patients with chronic rheumatic diseases. Future studies should examine these variables.
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Affiliation(s)
- Lut Berben
- Department of Nursing Development, University Children's Hospital Basel, Switzerland,Department of Rheumatology, University Hospital Basel, Switzerland
| | - Nora Sigg
- Department of Paediatric Rheumatology, University Children's Hospital Basel, Switzerland
| | - Mary Louise Daly
- Department of Nursing Development, University Children's Hospital Basel, Switzerland,Department of Rheumatology, University Hospital Basel, Switzerland,Department of Paediatric Rheumatology, University Children's Hospital Basel, Switzerland
| | - Stefan Bachmann
- Department of Pediatric Rheumatology, Cantonal Hospital Graubünden, Switzerland
| | - Walter Baer
- Department of Pediatric Rheumatology, Cantonal Hospital Graubünden, Switzerland
| | - Gérald Berthet
- Department of Paediatric Rheumatology, Cantonal Hospital Aarau, Switzerland
| | - Isabel Bolt
- Department of Paediatric Rheumatology, University Children's Hospital Bern, Switzerland
| | - Diana Dan
- Department of Rheumatology, Lausanne University Hospital and Lausanne University, Switzerland
| | | | | | - Paul Hasler
- Department of Rheumatology, Cantonal Hospital Aarau, Switzerland
| | - Michaël Hofer
- Department of Paediatric Rheumatology of Suisse Romande, Lausanne University Hospital, Switzerland,Department of Paediatric Rheumatology Geneva University Hospital, Switzerland
| | - Christian Huemer
- Department of Paediatric Rheumatology, Children's Hospital of Eastern Switzerland, Switzerland
| | - Daniela Kaiser
- Department of Paediatric Rheumatology, Cantonal Hospital Lucerne, Switzerland
| | - Natalie Marcoli
- Department of Rheumatology, Regional Hospital Lugano, Switzerland
| | - Seraina Palmer Sarott
- Department of Paediatric Rheumatology, University Children's Hospital Zürich, Switzerland
| | - Yella Rottländer
- Department of Rheumatology, Cantonal Hospital St Gallen, Switzerland
| | - Gernot Schmid
- Department of Rheumatology, Cantonal Hospital Lucerne, Switzerland
| | - Christa Soennichsen
- Department of Paediatric Rheumatology, Cantonal Hospital Winterthur, Switzerland
| | | | - Federica Vanoni
- Instituto Pediatrico della Svizzera Italiana, Bellinzona, Switzerland
| | - Lukas Wildi
- Department of Rheumatology, Cantonal Hospital Winterthur, Switzerland
| | - Thomas Daikeler
- Department of Rheumatology, University Hospital Basel, Switzerland
| | - Andreas Woerner
- Department of Paediatric Rheumatology, University Children's Hospital Basel, Switzerland
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Dobrota R, Jordan S, Juhl P, Maurer B, Wildi L, Bay-Jensen AC, Karsdal MA, Herrick AL, Distler JHW, Allanore Y, Hoffmann-Vold AM, Siebuhr AS, Distler O. Circulating collagen neo-epitopes and their role in the prediction of fibrosis in patients with systemic sclerosis: a multicentre cohort study. Lancet Rheumatol 2021; 3:e175-e184. [PMID: 38279380 DOI: 10.1016/s2665-9913(20)30385-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Extracellular matrix remodelling is a hallmark of systemic sclerosis. We evaluated extracellular matrix neo-epitopes as potential serum biomarkers for progression of fibrosis in systemic sclerosis. METHODS We included patients meeting the 2013 American College of Rheumatology and European League Against Rheumatism criteria and healthy controls from a derivation and validation cohort. The primary outcome was progression of fibrosis at follow-up, defined as decline in percentage of predicted forced vital capacity of 10% or more in patients with interstitial lung disease or increase in modified Rodnan skin score of 25% or more and more than 5 points at a 1-year follow-up visit. Longitudinal assessment and biobanking followed European Scleroderma Trials and Research standards. Extracellular matrix-degradation (BGM, C3M, C4M, and C6M) and extracellular matrix-formation neo-epitopes (PRO-C1, PRO-C3, PRO-C4, PRO-C5, and PRO-C6) were measured in serum using validated ELISAs. FINDINGS Between Aug 18, 2011, and Jan 19, 2015, 149 patients with systemic sclerosis (27 [18%] progressors and 122 [82%] non-progressors) and 29 healthy controls were included in the derivation cohort. Concentrations of type III and IV collagen neo-epitopes were higher in patients with systemic sclerosis compared with healthy controls and were significantly associated with systemic sclerosis in univariable logistic regression. Concentrations of degradation neo-epitopes of type III and IV collagens and their turnover ratios distinguished between progressors and non-progressors (C3M area under the curve 0·77 [95% CI 0·67-0·86], p<0·0001; PRO-C3:C3M 0·70 [0·59-0·80], p=0·0013; C4M 0·73 [0·63-0·82], p<0·0001; PRO-C4:C4M 0·75 [0·64-0·86], p<0·0001). 384 patients with systemic sclerosis (73 [19%] progressors) and 60 healthy controls were included in the multicentre validation cohort between April 17, 2003, and Jan 24, 2017. Analysis of the validation cohort confirmed that neo-epitopes of type III and IV collagens are changed in progressors. In a pooled analysis of both cohorts, the serum concentrations of formation neo-epitopes PRO-C3 and PRO-C4 and the turnover ratio of type IV collagen (PRO-C4:C4M) were higher in skin progressors. The turnover ratio of type IV collagen and PRO-C3 significantly predicted skin progression in a multivariable model adjusted for modified Rodnan skin score, sex, and age. INTERPRETATION These data suggest that neo-epitopes of type III and IV collagens are promising biomarkers for the assessment and prediction of extracellular matrix remodelling in systemic sclerosis. They could be used in clinical practice to risk stratify patients at risk of progression of fibrosis. FUNDING None.
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Affiliation(s)
- Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pernille Juhl
- Immuno-Science, Nordic Bioscience, Biomarker and Research, Herlev, Denmark; Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas Wildi
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Ariane L Herrick
- Division of Musculoskeletal & Dermatological Sciences, The University of Manchester, Salford Royal Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jörg H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Yannick Allanore
- INSERM U1016, Department of Rheumatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | | | - Anne Sofie Siebuhr
- Immuno-Science, Nordic Bioscience, Biomarker and Research, Herlev, Denmark
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Alder H, Marx C, Steurer J, Wertli M, Korner-Nievergelt P, Tamborrini G, Langenegger T, Eichholzer A, Andor M, Krebs A, Michel B, Wildi L. RheumaTool, a novel clinical decision support system for the diagnosis of rheumatic diseases, and its first validation in a retrospective chart analysis. Swiss Med Wkly 2020; 150:w20369. [PMID: 33227823 DOI: 10.4414/smw.2020.20369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS RheumaTool is a clinical decision support system designed to support the diagnostic process in rheumatology by presenting a differential diagnosis list after the input of clinical information. The objective of this study was to evaluate the performance of RheumaTool in detecting the correct diagnosis in referrals to a rheumatology clinic. METHODS In this retrospective chart analysis, data were gathered from patients with musculoskeletal complaints and an uncertain diagnosis who were referred to a Swiss tertiary rheumatology outpatient clinic. Data were entered into RheumaTool in a standardised fashion, while the principal diagnoses in the medical reports were blinded. RheumaTool’s output was compared to the correct diagnoses, established either by widely accepted diagnostic criteria or through the expert consensus of independent rheumatologists. Diagnostic precision, the primary endpoint, was defined as the proportion of correctly diagnosed cases among all cases. RESULTS One hundred and sixty cases with 46 different diseases were included in this analysis. RheumaTool correctly diagnosed 40% (95% confidence interval 32.4–48.1) of all cases. In 63.8% (95% confidence interval 55.7–71.1), the correct diagnosis was present in a differential diagnosis list consisting of a median of two diagnoses. CONCLUSION In this first validation, RheumaTool provides a useful list of differential diagnoses. However, there is not sufficient diagnostic reliability for unfiltered data entry, especially in patients with multiple concomitant musculoskeletal disorders. This must be taken into account when using RheumaTool.
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Affiliation(s)
- Hannes Alder
- UniversitätsSpital Zürich, Rheumatology, Switzerland
| | | | - Johann Steurer
- Horten Centre for patient-oriented research and knowledge transfer, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Maria Wertli
- Horten Centre for patient-oriented research and knowledge transfer, UniversitätsSpital Zürich, Zurich, Switzerland / Department of General Internal Medicine, Bern University Hospital, University of Bern, Switzerland
| | | | | | | | | | - Michael Andor
- Rheumatologie im Zürcher Oberland, Uster, Switzerland
| | - Andreas Krebs
- Rheumatologie im Zürcher Oberland, Uster, Switzerland
| | | | - Lukas Wildi
- Kantonsspital Winterthur, Rheumatology, Winterthur, Switzerland
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Semmel B, Huber U, Wildi L. [CME: Crowned-Dens-Syndrome - the Chameleon of Neck Pain]. Praxis (Bern 1994) 2020; 109:939-943. [PMID: 32933384 DOI: 10.1024/1661-8157/a003536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CME: Crowned-Dens-Syndrome - the Chameleon of Neck Pain Abstract. Crowned Dens Syndrome (CDS) is a rare, under-diagnosed differential diagnosis of acute neck pain. Diagnosis is a challenge in clinical practice due to the similarity of symptoms to other diseases. Knowing this differential diagnosis of acute neck pain, unnecessary examinations and expensive therapy attempts can be avoided with a targeted approach. With this article we would like to sensitize colleagues accordingly.
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Affiliation(s)
- Botond Semmel
- Departement Medizin, Klinik für Innere Medizin und Fachbereich Rheumatologie, Kantonsspital Winterthur
| | - Ursula Huber
- Departement Medizin, Klinik für Innere Medizin und Fachbereich Rheumatologie, Kantonsspital Winterthur
| | - Lukas Wildi
- Departement Medizin, Klinik für Innere Medizin und Fachbereich Rheumatologie, Kantonsspital Winterthur
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Semmel B, Huber U, Wildi L. [CME Answers: Crowned Dens Syndrome - the Chameleon of Neck Pain]. Praxis (Bern 1994) 2020; 109:1033-1034. [PMID: 33050808 DOI: 10.1024/1661-8157/a003537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CME Answers: Crowned Dens Syndrome - the Chameleon of Neck Pain Abstract. Crowned Dens Syndrome (CDS) is a rare, under-diagnosed differential diagnosis of acute neck pain. Diagnosis is a challenge in clinical practice due to the similarity of symptoms to other diseases. Knowing this differential diagnosis of acute neck pain, unnecessary examinations and expensive therapy attempts can be avoided with a targeted approach. With this article we would like to sensitize colleagues accordingly.
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Affiliation(s)
- Botond Semmel
- Departement Medizin, Klinik für Innere Medizin und Fachbereich Rheumatologie, Kantonsspital Winterthur
| | - Ursula Huber
- Departement Medizin, Klinik für Innere Medizin und Fachbereich Rheumatologie, Kantonsspital Winterthur
| | - Lukas Wildi
- Departement Medizin, Klinik für Innere Medizin und Fachbereich Rheumatologie, Kantonsspital Winterthur
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Wildi L, Flatz A, von Elm E. [Is chondroitin effective in arthritis?]. Praxis (Bern 1994) 2016; 105:587-588. [PMID: 27167482 DOI: 10.1024/1661-8157/a002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Lukas Wildi
- 1 Klinik für Rheumatologie, Universitätsspital Zürich
| | - Aline Flatz
- 2 Cochrane Schweiz, Institut universitaire de médecine sociale et préventive, Lausanne
| | - Erik von Elm
- 2 Cochrane Schweiz, Institut universitaire de médecine sociale et préventive, Lausanne
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Abstract
Osteoarthritis is the most frequent joint disorder and substantially affects patient quality of life. As an age-related disease it leads to an increasing financial burden for the healthcare system due to the current demographic changes. Osteoarthritis affects every single tissue in the joint. The identification of the source of disease symptoms is the key to a successful management. Therapeutic approaches include non-pharmacological and pharmacological treatment. Surgery is the therapeutic end stage (e.g. total joint replacement, high tibial osteotomy and arthrodesis). This overview focuses on the pharmacological treatment whereas the clinical manifestations and non-pharmacological approaches are only briefly dealt with.
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Affiliation(s)
- L Wildi
- Rheumaklinik, UniversitätsSpital Zürich, Gloriastr. 25, 8091, Zürich, Schweiz,
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10
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Wildi L. [Position of Lukas Wildi, Zurich]. Praxis (Bern 1994) 2014; 103:615-616. [PMID: 24979818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Klug S, Lewandowski C, Merker HJ, Stahlmann R, Wildi L, Neubert D. In vitro and in vivo studies on the prenatal toxicity of five virustatic nucleoside analogues in comparison to aciclovir. Arch Toxicol 1991; 65:283-91. [PMID: 1953347 DOI: 10.1007/bf01968962] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Several virustatic agents are known to be teratogenic in laboratory animals. Since routinely performed in vivo studies do not always offer the best conditions to detect the teratogenic potential of a drug, we used a combined in vivo/in vitro approach for comparative studies on the prenatal toxicity of five nucleoside analogues. Rat embryos were exposed for 48 h to various concentrations of vidarabine-phosphate (VAP), ganciclovir (GCV), 2',3'-dideoxyadenosine (ddA), 2',3'-dideoxycytidine (ddC) and zidovudine (= azidothymidine, AZT) in a whole-embryo culture system. The steepness of the concentration-response curves as well as the induced abnormality pattern (head, neural tube, shape) were similar for these compounds. However, a wide range in embryotoxic potency was observed: VAP was the most potent compound (100% abnormal embryos at 25 microM) in this in vitro system, while AZT showed the lowest potency to interfere with normal embryonic development (40% abnormal embryos at 3000 microM). In addition to these experiments we treated rats on day 10 of gestation with three s.c. injections (8 a.m.; 12 a.m.; 4 p.m.) of 200 mg of each drug/kg body wt. The embryos were evaluated on day 11.5 of gestation, i.e. at a time of development corresponding to the developmental stage at the end of the whole-embryo culture. The same criteria were used as during the in vitro studies for the evaluation of these in vivo exposed embryos. With VAP and GCV we obtained similar results with both exposure routes (in vitro and in vivo), while no abnormalities were detectable with the other compounds after exposure in utero.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Klug
- Institut für Toxikologie und Embryopharmakologie, Freie Universität Berlin, Federal Republic of Germany
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Klug S, Lewandowski C, Wildi L, Neubert D. Bovine serum: An alternative to rat serum as a culture medium for the rat whole embryo culture. Toxicol In Vitro 1990; 4:598-601. [DOI: 10.1016/0887-2333(90)90123-b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Klug S, Lewandowski C, Wildi L, Neubert D. All-trans retinoic acid and 13-cis-retinoic acid in the rat whole-embryo culture: abnormal development due to the all-trans isomer. Arch Toxicol 1989; 63:440-4. [PMID: 2619557 DOI: 10.1007/bf00316445] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
9.5-day-old rat embryos were exposed to 3 micrograms 13-cis retinoic acid (13-cis-RA)/ml culture medium or 1 microgram all-trans retinoic acid (all-trans-RA)/ml culture medium for different time intervals of the culture period (test substance-exposure periods alternated with test substance-free periods). These studies were performed to confirm the hypothesis (Klug et al. 1989) that the effect of 13-cis-RA on embryonic development in vitro is predominantly caused by its isomerisation to all-trans-RA. A 12 h exposure of the rat embryos to 13-cis-RA during different periods of culture did not interfere with normal development. However, a 12 h exposure of the embryos to all-trans-RA in the first three quarters of the culture period significantly interfered with normal development and caused clear-cut and typical abnormalities. Embryonic exposure to 13-cis-RA, for periods of more than 12 h, caused severe interference with normal development and led to branchial effects very similar to those observed following to a 12 h exposure to all-trans-RA.
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Affiliation(s)
- S Klug
- Institut für Toxikologie und Embryopharmakologie, Freie Universität Berlin
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