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Leacche M, Boeve T, Manandhar Shrestha N, Kelty C, Perinjelil V, Berner M, Lee S, Loyaga-Rendon R, Dickinson M, Grayburn R, Fermin D, Jani M, Jovinge S. Changing Landscape of Heart Transplantation in the US after Implementation of the New Allocation System: A UNOS Data Registry Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Soldavini J, Berner M. Using Photovoice to Engage Youth in Evaluating Food for the Summer. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Berner M, Lattmann T, Stalder P, Wigger P. Vein Patch Closure Using Below the Knee Greater Saphenous Vein for Femoral Endarterectomy Procedures is Not Always a Safe Choice. EJVES Short Rep 2017; 37:22-24. [PMID: 29234736 PMCID: PMC5721262 DOI: 10.1016/j.ejvssr.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/25/2017] [Accepted: 10/08/2017] [Indexed: 12/12/2022] Open
Abstract
Background The complication of vein patch rupture is well described after carotid patch angioplasty; however, there is a paucity of data about the safety of vein patch closure in the setting of femoral endarterectomy. Methods/results From May 2012 to May 2015, 115 femoral endarterectomies with patch closure were performed. A patch rupture occurred in three cases (2.6%) with a mortality rate of 66% (2/3). In all cases the greater saphenous vein below the knee was used as patch material. Discussion/conclusion Vein patches, particularly from small calibre veins, should be excluded in femoral endarterectomy procedures as they pose a substantial risk of rupture. Choice of patch material for endarterectomy procedures of the common femoral artery may be crucial. Patch rupture after use of the greater saphenous vein occurs in 3% of cases. A particular risk of rupture occurs after the use of below knee greater saphenous vein patches. Patch rupture is associated with a high mortality rate.
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Affiliation(s)
- M Berner
- Clinics for Vascular Surgery, Kantonsspital Winterthur, Switzerland
| | - Th Lattmann
- Clinics for Vascular Surgery, Kantonsspital Winterthur, Switzerland
| | - Ph Stalder
- Clinics for Vascular Surgery, Kantonsspital Winterthur, Switzerland
| | - P Wigger
- Clinics for Vascular Surgery, Kantonsspital Winterthur, Switzerland
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Abstract
BACKGROUND Sexual dysfunction associated with psychotropic drugs is a threat to patient quality of life and a major reason for non-compliance. Psychotropic agents can impair the sexual response in different ways due to their neurobiological mode of action. OBJECTIVE Presentation of the frequencies of sexual functional disorders for selected psychopharmacological groups and the available treatment modalities. METHODS Literature search, selection and review of relevant studies. RESULTS The most relevant groups for impairments are antidepressants and antipsychotics due to the serotonin agonistic and anti-dopaminergic properties as well as the prolactin increasing characteristics. Agents with a favorable side effects profile are now available. All phases of the sexual response are affected. DISCUSSION The treatment of psychiatric disorders should follow a comprehensive treatment plan that anticipates a likely sexual dysfunction at the initiation of treatment. The main aim is improvement of the underlying primary disorder. Some limited evidence-based treatment strategies are available.
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Affiliation(s)
- M Berner
- Klinik für Psychiatrie und Psychotherapeutische Medizin, Städtisches Klinikum Karlsruhe, Kaiserallee 10, 76133, Karlsruhe, Deutschland. .,Medizinische Fakultät, Albert-Ludwigs-Universität, Breisacher Str. 153, 79110, Freiburg, Deutschland.
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Buchholz A, Kahl B, Piontek D, Friedrichs A, Röhrig J, Rist F, Berner M, Kraus L. Adaption und empirische Prüfung einer Zuweisungsleitlinie für die Weiterbehandlung nach dem qualifizierten Alkoholentzug: Studiendesign und Ergebnisse zur Machbarkeit. Suchttherapie 2015. [DOI: 10.1055/s-0035-1557507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Friedrichs A, Kraus L, Berner M, Schippers G, Broekman T, Rist F, Piontek D, Röhrig J, Buchholz A. Adaption einer niederländischen Zuweisungsleitlinie für Patienten nach qualifiziertem Alkoholentzug – Ergebnisse einer Delphi-Befragung. Suchttherapie 2013. [DOI: 10.1055/s-0033-1354394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Friedrichs
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - L. Kraus
- IFT Institut für Therapieforschung, München
| | - M. Berner
- Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
| | - G. Schippers
- Academic Medical Center, Amsterdam Institute for Addiction Research (AIAR), Amsterdam, The Netherlands
| | | | - F. Rist
- Institut für Klinische Psychologie, Westfälische Wilhelms-Universität Münster
| | - D. Piontek
- IFT Institut für Therapieforschung, München
| | - J. Röhrig
- Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
| | - A. Buchholz
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
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Röhrig J, Flaig S, Niebling W, Ruf D, Wahl S, Berner M. Früherkennung und Behandlung alkoholbezogener Störungen: Eine Prä-Post-Studie zur Verbesserung der Vernetzung von Hausarzt und Suchtberatung. Suchttherapie 2011. [DOI: 10.1055/s-0031-1284361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Haller G, Camparini-Righini N, Kern C, Pfister R, Morales M, Berner M, Clergue F, Irion O. Indicateurs sécurité en obstétrique : une étude Delphi. ACTA ACUST UNITED AC 2010; 39:371-8. [DOI: 10.1016/j.jgyn.2010.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 05/18/2010] [Accepted: 05/26/2010] [Indexed: 11/28/2022]
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Berner M, Schmidt E, Weinhäupl C, Günzler C, Kriston L, Zahradnik HP. Prävalenz, Diagnostik und Therapie weiblicher sexueller Funktionsstörungen in der gynäkologischen Praxis – Eine deutschlandweite Repräsentativbefragung. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0029-1241024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ruf D, Berner M, Kriston L, Lohmann M, Mundle G, Lorenz G, Niebling W, Härter M. Cluster-randomized controlled trial of dissemination strategies of an online quality improvement programme for alcohol-related disorders. Alcohol Alcohol 2009; 45:70-8. [PMID: 19889887 DOI: 10.1093/alcalc/agp079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany. METHODS In a cluster-randomized controlled trial, 112 general practices were randomized into three groups. The first group (n = 43) received access to the online system and a training programme for the general practitioners (GPs). The second group (n = 42) additionally received education for the whole practice team. The third group (n = 27) acted as control and received only access to the online system. RESULTS Two thousand six hundred and forty-seven practitioners were asked to take part in the study, and it was possible to randomize 112 (4%) practices. There were no significant differences concerning the use of the system between the groups: 41.9% of the GPs in the first group, 42.9% in the second group and 44.4% in the control group used the system. In terms of only the system users, 55.6% of the GPs in the first group, 33.3% in the second group and 8.3% in the control group used the system six times or more (P = 0.019). Diagnostic assessments made by the GPs in the groups differed substantially: 72.2% of diagnoses in the first group were correct, while this figure lay at 69.7% in the second group and 36.4% in the control group (P = 0.034). CONCLUSIONS No effect of the additional training on the primary outcome (acceptance) was identified, but on two of the secondary outcomes. Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable. The study is registered at ClinicalTrials.gov: NCT00314067. This article conforms to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement (Moher et al., 2001; Campbell et al., 2004).
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Affiliation(s)
- D Ruf
- Department of Psychiatry and Psychotherapy, Section of Clinical Epidemiology and Health Services Research, University Medical Centre Freiburg, D-79104 Freiburg, Germany.
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Pfister R, Launoy V, Vassant C, Martinet M, Picard C, Bianchi J, Berner M, Bullinger A. Transition de l'alimentation passive à l'alimentation active chez le bébé prématuré. Enfance 2009. [DOI: 10.3917/enf.604.0317] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Berner M, Günzler C, Frick K, Kriston L, Loessl B, Brück R, Gann H, Batra A, Mann K. Finding the ideal place for a psychotherapeutic intervention in a stepped care approach--a brief overview of the literature and preliminary results from the Project PREDICT. Int J Methods Psychiatr Res 2008; 17 Suppl 1:S60-4. [PMID: 18543364 PMCID: PMC6879086 DOI: 10.1002/mpr.250] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS To provide an overview over empirical evidence regarding stepped care approaches that include psychotherapies. To present own preliminary study results in alcohol dependent patients. METHODS Publications were searched in the databases Medline, PsycINFO and the internet search engine Google Scholar. Inclusion criteria were psychosocial treatment and psychiatric disorders. Our own study consists of two steps. In step 1 patients receive anti-craving medication or placebo and Medical Management (MM). After a relapse to heavy drinking patients can step up and after randomization they either continue with the same treatment or they receive additional alcoholism specific psychotherapy (ASP). RESULTS Evidence suggests that stepped care might be efficacious in patients with obsessive-compulsive behavior and depression. There is no evidence for efficacy in problem drinkers. Results of our own study show that the completer rate in MM alone is higher than in ASP with MM, but there are no significant differences concerning age, sex and disease severity between completer and non-completer in both study arms. CONCLUSIONS Further research with regard to stepped care in alcohol dependent patients is needed. An introduction of the psychotherapy at earlier stages might be sensible.
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Affiliation(s)
- M Berner
- Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Freiburg Germany.
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Ruf D, Berner M, Lohmann M, Mundle G, Lorenz G, Niebling W, Kriston L, Härter M. Einführung in www.alkohol-leitlinie.de - Evaluation einer computergestützten Fortbildung für Hausärzte und Arzthelferinnen zur Diagnostik und Behandlung alkoholbezogener Störungen. ACTA ACUST UNITED AC 2007. [DOI: 10.1055/s-2007-992797] [Citation(s) in RCA: 1] [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: 10/22/2022]
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Ruf D, Berner M, Lohmann M, Mundle G, Lorenz G, Niebling W, Härter M. www.alkohol-leitlinie.de - Informationsangebote und Online-Fortbildung zum Thema „alkoholbezogene Störungen”. ACTA ACUST UNITED AC 2006. [DOI: 10.1055/s-2006-942317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Extracts of the plant Hypericum perforatum L. (popularly called St. John's wort) have been used in folk medicine for a long time for a range of indications including depressive disorders. OBJECTIVES To investigate whether extracts of hypericum are more effective than placebo and as effective as standard antidepressants in the treatment of depressive disorders in adults; and whether they have have less adverse effects than standard antidepressant drugs. SEARCH STRATEGY Trials were searched in computerized databases (Cochrane Collaboration Depression, Anxiety & Neurosis Group Clinical Trials Registers; PubMed); by checking bibliographies of pertinent articles; and by contacting manufacturers and researchers. SELECTION CRITERIA Trials were included if they: (1) were randomized and double-blind; (2) included patients with depressive disorders; (3) compared extracts of St. John's wort with placebo or standard antidepressants; and (4) included clinical outcomes such as scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS Information on patients, interventions, outcomes and results was extracted by at least two independent reviewers using a standard form. The main outcome measure for comparing the effectiveness of hypericum with placebo and standard antidepressants was the responder rate ratio (responder rate in treatment group/responder rate in control group). The main outcome measure for adverse effects was the number of patients dropping out for adverse effects. MAIN RESULTS A total of 37 trials, including 26 comparisons with placebo and 14 comparisons with synthetic standard antidepressants, met the inclusion criteria. Results of placebo-controlled trials showed marked heterogeneity. In trials restricted to patients with major depression, the combined response rate ratio (RR) for hypericum extracts compared with placebo from six larger trials was 1.15 (95% confidence interval (CI), 1.02-1.29) and from six smaller trials was 2.06 (95% CI, 1.65 to 2.59). In trials not restricted to patients with major depression, the RR from six larger trials was 1.71 (95% CI, 1.40-2.09) and from five smaller trials was 6.13 (95% CI, 3.63 to 10.38). Trials comparing hypericum extracts and standard antidepressants were statistically homogeneous. Compared with selective serotonin reuptake inhibitors (SSRIs) and tri- or tetracyclic antidepressants, respectively, RRs were 0.98 (95% CI, 0.85-1.12; six trials) and 1.03 (95% CI, 0.93-1.14; seven trials). Patients given hypericum extracts dropped out of trials due to adverse effects less frequently than those given older antidepressants (Odds ratio (OR) 0.25; 95% CI, 0.14-0.45); such comparisons were in the same direction, but not statistically significantly different, between hypericum extracts and SSRIs (OR 0.60, 95% CI, 0.31-1.15). AUTHORS' CONCLUSIONS Current evidence regarding hypericum extracts is inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that the tested hypericum extracts have minimal beneficial effects while other trials suggest that hypericum and standard antidepressants have similar beneficial effects. As the preparations available on the market might vary considerably in their pharmaceutical quality, the results of this review apply only to the products tested in the included studies.
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Affiliation(s)
- K Linde
- Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität München, Kaiserstr. 9, Munich, Germany, 80801.
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Bechthold A, Weitnauer G, Luzhetskyy A, Berner M, Bihlmeier C, Boll R, Dürr C, Frerich A, Hofmann C, Mayer A, Treede I, Vente A, Luzhetskyy M. Glycosyltransferases and other tailoring enzymes as tools for the generation of novel compounds. Ernst Schering Res Found Workshop 2005:147-63. [PMID: 15645720 DOI: 10.1007/3-540-27055-8_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- A Bechthold
- Institut für Pharmazeutische Wissenschaften, Albert-Ludwigs-Universität Freiburg, Germany.
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Berner M. [Effectiveness of St. John's Wort in major depression apparently not indicated]. Forsch Komplementarmed Klass Naturheilkd 2001; 8:307-9. [PMID: 11760712 DOI: 10.1159/000057242] [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: 11/19/2022]
Affiliation(s)
- M Berner
- Abteilung für Psychiatrie und Psychotherapie mit Poliklinik der Universitätsklinik für Psychiatrie und Psychosomatik, Freiburg i. Br.
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Abstract
Primary pulmonary hypertension is a rare disease in childhood associated with a poor prognosis. However, during the past 10 years, pulmonary vasodilator treatment has somewhat improved its prognosis. Long term continuous infusion of prostacyclin (epoprostenol) has been shown to improve physical capacity and to reduce mortality in primary and secondary pulmonary hypertension. It has been reported in adults that daily repetitive inhalation of iloprost, a prostacyclin analogue, seems also suitable for long term therapy of pulmonary hypertension. Repetitive inhalation of iloprost was administered to a 5 year old boy with severe primary pulmonary hypertension. He showed continuous clinical improvement without any side effects over the three years of treatment. This treatment may offer an alternative to continuous intravenous prostacyclin infusion and obviates the need for a permanent central venous catheter.
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Affiliation(s)
- M Beghetti
- Cardiology Unit, Hôpital des Enfants, Department of Paediatrics, University Hospital of Geneva, 1211 Genève 14, Switzerland.
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Stan CM, Boulvain M, Bovier PA, Auckenthaler R, Berner M, Irion O. Choosing a strategy to prevent neonatal early-onset group B streptococcal sepsis: economic evaluation. BJOG 2001; 108:840-7. [PMID: 11510710 DOI: 10.1111/j.1471-0528.2001.00201.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/29/2022]
Abstract
OBJECTIVE To determine the most appropriate strategy to prevent neonatal streptococcal sepsis in a setting with a low incidence of the disease. DESIGN Decision analysis and economic evaluation. SETTING Geneva University Hospitals, Switzerland. POPULATION Pregnant women at 35-37 weeks of gestation and in labour. METHODS Local data and data from the literature were used in a decision analysis to compare the current policy of antibiotic administration at Geneva University Hospitals with the recommended preventive strategies. MAIN OUTCOME MEASURES Number of episodes of sepsis averted; cost and number needed to treat to prevent one episode of sepsis; and proportion of women receiving antibiotics during labour. RESULTS Compared with the current policy, the risk factors strategy would prevent 69 streptococcal sepsis per million deliveries and the screening strategy would prevent 102 cases of sepsis per million deliveries. Cost per averted sepsis case would be 60 pounds, 700 and 473 pounds, 600, respectively. The number needed to treat to prevent one sepsis would be 1,087 with a risk factors strategy and 1,029 with a screening strategy. Preventive strategies would increase the proportion of women receiving antibiotics during labour from 6% with the current policy, to 13.5% and 16.5% respectively. CONCLUSIONS Preventive strategies are more effective than the current policy, but imply increased hospital costs and a notable increase in the proportion of women receiving antibiotics during labour, which may be unjustified in a low incidence setting.
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Affiliation(s)
- C M Stan
- Department of Obstetrics and Gynaecology, Geneva University Hospitals, Switzerland
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Rimensberger PC, Spahr-Schopfer I, Berner M, Jaeggi E, Kalangos A, Friedli B, Beghetti M. Inhaled nitric oxide versus aerosolized iloprost in secondary pulmonary hypertension in children with congenital heart disease: vasodilator capacity and cellular mechanisms. Circulation 2001; 103:544-8. [PMID: 11157720 DOI: 10.1161/01.cir.103.4.544] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inhaled nitric oxide (iNO) has been used to assess the vasodilator capacity of the pulmonary vascular bed in children with congenital heart disease and elevated pulmonary vascular resistance. Inhaled iloprost is a pulmonary vasodilator for the long-term treatment of pulmonary hypertension (PHT). Because these 2 vasodilators act through different pathways (release of cGMP or cAMP, respectively), we compared the pulmonary vasodilator capacity of each. METHODS AND RESULTS A total of 15 children with congenital heart disease and PHT who had elevated pulmonary vascular resistance (preoperative, n=10; immediately postoperative, n=5) were first given 20 ppm of iNO for 10 minutes; then, after baseline values were reached again, they were given aerosolized iloprost at 25 ng. kg(-1). min(-1) for another 10 minutes. Finally, iNO and iloprost were given simultaneously for 10 minutes. With iNO, the pulmonary vascular resistance and systemic vascular resistance ratio decreased from 0.48+/-0.38 to 0.27+/-0.16 (P:<0.001). Similarly, iloprost decreased the ratio from 0.49+/-0.38 to 0.26+/-0.11 (P:<0.05). The combination had no additional effect on the resistance ratio. Plasma cGMP increased from 17.6+/-11.9 to 34.7+/-21.4 nmol/L during iNO (P:<0.01), and plasma cAMP increased from 55.7+/-22.9 to 65.1+/-21.2 nmol/L during iloprost inhalation (P:<0.05). CONCLUSIONS In children with PHT and congenital heart disease, both iNO and aerosolized iloprost are equally effective in selectively lowering pulmonary vascular resistance through an increase in cGMP or cAMP, respectively. However, the combination of both vasodilators failed to prove more potent than either substance alone. Aerosolized iloprost might be an alternative to iNO for early testing of vascular reactivity and for the postoperative treatment of acute PHT.
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Affiliation(s)
- P C Rimensberger
- Pediatric and Neonatal Critical Care Division, Hôpital des Enfants, University Hospital of Geneva, Switzerland
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Vauth R, Berner M, Wetterauer U, Berger M. [Prescribing of sildenafil by national insurance program physicians. What basic sexual medicine qualification is required?]. Fortschr Med Orig 2001; 118:173-9. [PMID: 11217683] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The role of sildenafil in the treatment of erectile dysfunction is discussed. Especially in primary care there is a necessity to weigh the individual cost-benefit-ratio. Functional analysis of erectile dysfunction, exclusion of psychiatric and organic comorbidity, identification of sexual deviance and couple counseling about the advantages and disadvantages of sildenafil prescription are the core prerequisites of sildenafil application in primary care. The counseling model of PLIS-SIT is proposed as a guideline for counseling process. Current approaches of education for general practitioners are reviewed and the integration in a recently developed training for management of psychiatry and psychosomatic illness in general medical settings is proposed. Finally open questions for research and quality management are discussed.
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Affiliation(s)
- R Vauth
- Abteilung für Psychiatrie und Psychotherapie der Universitätsklinik Freiburg
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Galetto Lacour A, Zamora S, Bertrand R, Brighi Perret L, Auckenthaler R, Berner M, Suter S. [Colonization by Ureaplasma urealyticum and chronic lung disease in premature newborn infants under 32 weeks of gestation]. Arch Pediatr 2001; 8:39-46. [PMID: 11218582 DOI: 10.1016/s0929-693x(00)00164-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 10/18/2022]
Abstract
UNLABELLED Colonization of the respiratory tract of premature newborn infants by genital mycoplasma is suspected to be associated with chronic lung disease. METHODS AND PATIENTS We prospectively determined the prevalence of genital mycoplasma colonization with nasopharyngeal or endotracheal culture in preterm neonates younger than 32 weeks gestation and its possible association with the development of chronic lung disease in a prospective study. RESULTS Fifty-nine infants were enrolled and 11 (19%) were colonized with Ureaplasma urealyticum. In the subgroup of 45 ventilated infants, seven of seven U. urealyticum-positive infants developed chronic pulmonary disease versus ten of 38 (26%) of U. urealyticum-negative infants (relative risk [RR] = 3.8; 95% confidence interval [CI] 2.2 to 6.5, P < 0.001). U. urealyticum-colonized infants had a lower median birth weight (760 vs 1,083 g, P = 0.04), a lower gestational age (26 vs 28 weeks, P = 0.03), and a higher incidence of symptomatic patent ductus arteriosus (P = 0.03). These potential confounding factors may partially explain the association between U. urealyticum and chronic pulmonary disease. However, this association remained statistically significant when the analysis was restricted to infants with birth weight of 1,000 g or less (RR = 2.3; 95% CI 1.3 to 4, P = 0.02) or to infants with a patent ductus arteriosus (RR = 2; 95% CI 1.3 to 3.1, P = 0.02). CONCLUSION Colonization with U. urealyticum in ventilated preterm neonates younger than 32 weeks gestation is a significant risk factor of developing chronic pulmonary disease.
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Affiliation(s)
- A Galetto Lacour
- Département de pédiatrie, hôpital universitaire, hôpital des Enfants, 6, rue Willy-Donzé, 1211 Genève 14, Suisse
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Abstract
UNLABELLED In order to assess the current use of medical and social services of children of drug-abusing mothers in regard to their short term outcome in a Swiss urban community hospital, we compared hospital, private paediatricians and home nursing records of 37 of these children with 37 matched control children from birth to 18 months of age. Children of drug-abusing mothers (CDAM) experienced a longer neonatal hospital stay than control children with a median (25%-75%) of 26 days (10.5-52.5 days) versus 5 (5-6) days (P < 0.001), a substantial part of which, 8 days (3.5-26 days) versus 0 days (0-1 day) (P < 0.001) was not motivated by any specific medical treatment or nursing care. Before discharge, CDAM were referred to out of hospital nursing and social services for further management, but only 13% were effectively followed. More than 50% were lost to follow-up by their initial paediatrician after 1 year of life. CONCLUSION New ways to ensure better co-ordination between paediatricians and the social services (inside and outside the hospital) should be developed to shorten the neonatal hospitalisation period and improve the quality of follow-up.
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Affiliation(s)
- A Payot
- Department of Paediatrics, Hôpital des Enfants, Geneva, Switzerland.
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25
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Rimensberger PC, Beghetti M, Hanquinet S, Berner M. First intention high-frequency oscillation with early lung volume optimization improves pulmonary outcome in very low birth weight infants with respiratory distress syndrome. Pediatrics 2000; 105:1202-8. [PMID: 10835058 DOI: 10.1542/peds.105.6.1202] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The lack of decline in chronic lung disease of prematurity despite the generalized use of surfactant and alternative modes of ventilation such as high-frequency oscillation (HFO) has been attributed to some misunderstanding of how HFO has to be used. We used a new ventilatory strategy in very low birth weight (VLBW) infants, by initiating HFO immediately after intubation and attempting early lung volume optimization before surfactant was administered. STUDY DESIGN The outcome of 32 VLBW infants, managed with first intention HFO over a period of 24 months (September 1, 1996 and August 31, 1998) was compared by chart review with 39 historical controls, consecutively managed with conventional mechanical ventilation (CMV) over a period of 24 months (January 1, 1994 and December 31, 1995). SETTING An 11-bed tertiary care pediatric and neonatal intensive care unit of a university teaching hospital. RESULTS The 2 groups of patients were similar in demographic distribution of birth weight, gestational age, race, and gender. Patients on first intention HFO were ventilator-dependent (median [95% confidence interval]: 5 [3-6] vs 14 [6-23] days) and oxygen-dependent (12 [4-17] vs 51 [20-60] days) for a shorter time than patients on CMV. The incidence of chronic lung disease at 36 weeks of gestational age was significantly lower in the HFO group compared with the CMV group (0% vs 34%). CONCLUSIONS First intention HFO with early lung volume optimization shortened the need for respiratory support and improved pulmonary outcome of VLBW infants with respiratory distress syndrome significantly.
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Affiliation(s)
- P C Rimensberger
- Pediatric and Neonatal Intensive Care Unit, Hôpital des Enfants, University Hospital of Geneva, Geneva, Switzerland.
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26
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Beghetti M, Gervaix A, Haenggeli CA, Berner M, Rimensberger PC. Myocarditis associated with parvovirus B19 infection in two siblings with merosin-deficient congenital muscular dystrophy. Eur J Pediatr 2000; 159:135-6. [PMID: 10653351 DOI: 10.1007/s004310050034] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Linde K, Berner M. Commentary: has hypericum found its place in antidepressant treatment? BMJ 1999; 319:1539. [PMID: 10651472] [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: 02/15/2023]
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28
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Müller B, Belli DC, Viquerat F, Mentha G, Berner M, Spahi I, Bugmann P, Le Coultre C. Transplantation hépatique chez l'enfant : Expérience suisse. Arch Pediatr 1998. [DOI: 10.1016/s0929-693x(97)86916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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30
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Berner M. [Thoracoscopy. A tremendous progress for patients, a permanent challenge for thoracic surgeons]. Rev Med Suisse Romande 1997; 117:103-6. [PMID: 9173499] [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: 02/04/2023]
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31
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Bichel T, Spahr-Schopfer I, Berner M, Jaeggi E, Velkovski Y, Friedli B, Kalangos A, Faidutti B, Rouge JC. Successful weaning from cardiopulmonary bypass after cardiac surgery using inhaled nitric oxide. Paediatr Anaesth 1997; 7:335-9. [PMID: 9243693 DOI: 10.1046/j.1460-9592.1997.d01-82.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two cases of very difficult weaning from cardiopulmonary bypass after cardiac surgery in children with pulmonary hypertension and ventricular dysfunction are reported. Children fail to respond to conventional therapy combining nitrovasodilators and inotropic support and react successfully to combined inhaled nitric oxide (NO) and epinephrine or left atrial infused norepinephrine. Postoperative NO inhalation must be prolonged and no toxicity appears. Pulmonary endothelial function recovers only after several days.
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MESH Headings
- Administration, Inhalation
- Adrenergic Agonists/therapeutic use
- Aorta, Thoracic/abnormalities
- Aorta, Thoracic/surgery
- Aortic Stenosis, Subvalvular/surgery
- Bronchodilator Agents/therapeutic use
- Cardiac Surgical Procedures
- Cardiopulmonary Bypass/adverse effects
- Cardiotonic Agents/therapeutic use
- Child, Preschool
- Ductus Arteriosus, Patent/surgery
- Endothelium, Vascular/drug effects
- Epinephrine/therapeutic use
- Female
- Heart Atria
- Heart Septal Defects, Ventricular/surgery
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/etiology
- Infant
- Injections
- Lung/blood supply
- Lung/drug effects
- Nitric Oxide/administration & dosage
- Nitric Oxide/therapeutic use
- Norepinephrine/administration & dosage
- Norepinephrine/therapeutic use
- Respiratory System Agents/administration & dosage
- Respiratory System Agents/therapeutic use
- Time Factors
- Vasoconstrictor Agents/administration & dosage
- Vasoconstrictor Agents/therapeutic use
- Vasodilator Agents/therapeutic use
- Ventricular Dysfunction/drug therapy
- Ventricular Dysfunction/etiology
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Affiliation(s)
- T Bichel
- Department of Anaesthesiology, University Hospital of Geneva, Switzerland
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32
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Abstract
A shortage of small pediatric organ donors has led to the development of reduced size liver transplantation in children. However, the discrepancy between donor and recipient weight can limit the use of this procedure despite transplantation of the left lobe only. Monosegmental liver transplantation using segment III only was recently described. We report here the case of an 11 month old, 6.9 kg boy who received another monosegmental graft (segment II) from a 78 kg donor on an urgent basis. Because of the lack of parenchymal landmarks between segments II and III, sterile methylene blue solution was injected into the portal vein of segment III: parenchyma of this segment colored immediately and was resected accordingly. Three and a half years later, the growth, development, and nutrition of this child were normal. This procedure seems to be helpful when the left lobe of the graft is obviously too large.
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Affiliation(s)
- G Mentha
- Unité de transplantation, Clinique de Pédiatrie, Hôpital Cantonal Universitaire, Geneva, Switzerland
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33
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Habre W, Beghetti M, Roduit C, Girardin E, Vallotton M, Friedli B, Berner M. Haemodynamic and renal effects of dopexamine after cardiac surgery in children. Anaesth Intensive Care 1996; 24:435-9. [PMID: 8862639 DOI: 10.1177/0310057x9602400404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 02/02/2023]
Abstract
Dopexamine hydrochloride, a synthetic dopamine analog with predominantly beta and delta agonist properties, has been shown to improve cardiac performance and renal function in adults with heart failure. This study was designed to investigate the haemodynamic and renal effects of dopexamine in children after cardiac surgery. Seven children were selected in whom a need for postoperative vasodilation after cardiac surgery was anticipated. Haemodynamics and renal function were determined under baseline conditions and during a continuous infusion of dopexamine at 2 and 6 micrograms.kg-1.min-1 for 90 minutes, the sequence being randomized for the initial dose. Cardiac output was measured by thermodilution and glomerular filtration rate (GFR) and renal plasma flow (RPF) by the clearances of inulin and para-aminohippurate respectively. Dopexamine induced a dose-related increase in cardiac index (CI) expressed as mean (SD) from 3.5 (0.7) to 3.9 (0.76) and 4.5 (0.8) l.min.-1m-2 (both P < 0.05), and in heart rate (HR) from 107 (17) to 122 (17) and 136 (17) beats.min-1 (P < 0.05). Stroke volume index (SVI) and mean systemic pressure were unchanged, but pulmonary wedge pressure decreased from 14 (3) to 11 (4) and 12 (3) mmHg (both P < 0.05). Systemic vascular resistances (SVR) decreased from 24 (7) to 20 (5) mmHg.l-1.min-1.m-2 (P < 0.05), with dopexamine 6 micrograms.kg-1.min-1. Renal blood flow (RBF) increased from 319 (113) to 441 (230) and 410 (138) ml.min-1.m-2 (both P < 0.05), GFR from 115 (32) to 142 (34) and 146 (29) ml.min-1.1.73m-2 (both P < 0.05), urine output and fractional excretion of sodium respectively from 3.12 (2) to 7.16 (8) and 7.21 (6) ml.kg-1 (both P < 0.05) and from 2.24 (1) to 4.25 (3.4) (P < 0.05) and 3.15 (3.1)% (n.s.). The fraction of CI delivered to the kidneys, the fraction of RBF filtered in the kidneys, plasma renin activity and aldosterone levels remained unchanged. In children after cardiac surgery, dopexamine increases CI at the expense of a concomitant increase in heart rate and demonstrates few selective vascular systemic or intrinsic renal actions.
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Affiliation(s)
- W Habre
- Intensive Care Unit, University Pediatric Clinic, Hôpital des Enfants, Geneva, Switzerland
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34
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Berner M, Beghetti M, Spahr-Schopfer I, Oberhansli I, Friedli B. Inhaled nitric oxide to test the vasodilator capacity of the pulmonary vascular bed in children with long-standing pulmonary hypertension and congenital heart disease. Am J Cardiol 1996; 77:532-5. [PMID: 8629600 DOI: 10.1016/s0002-9149(97)89353-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nitric oxide-induced vasodilator capacity greatly varies among children with pulmonary hypertension and elevated vascular resistance. The decline of this selective response seems to parallel the progression of established vascular disease and thus may be helpful for the selection of patients for operation.
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Affiliation(s)
- M Berner
- Pediatric Intensive Care and Pediatric Cardiology, University Hospital of Geneva, Switzerland
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35
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Dralle H, Scheumann GF, Proye C, Bacourt F, Frilling A, Limbert F, Gheri G, Henry JF, Berner M, Niederle B. The value of lymph node dissection in hereditary medullary thyroid carcinoma: a retrospective, European, multicentre study. J Intern Med 1995; 238:357-61. [PMID: 7595172 DOI: 10.1111/j.1365-2796.1995.tb01210.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Clinical data of 139 patients with hereditary medullary thyroid carcinoma (HMTC) from nine european centres surgically treated from 1980 to 1991 were reviewed retrospectively to analyse the value of systematic versus selective lymphadenectomy (LA). Biochemical cure rate was significantly higher in patients who underwent LA compared to patients who did not. In nodal-positive HMTC, systematic LA compared to selective LA improved biochemical cure in small but not large tumours. In nodal-negative HMTC, systematic LA compared to selective LA could not improve biochemical cure in either small or large primary tumours. To prevent local recurrences with the risk of increased surgical and tumour-related morbidity, systematic LA should be performed in all HMTC patients regardless of the primary tumour stage. However, an improvement of biochemical cure by systematic LA seems to be possible only in nodal-positive small primary tumours without distant metastases.
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Affiliation(s)
- H Dralle
- Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule, Hannover, Germany
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36
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Aas K, Andersen T, Becher R, Berner M, Holmen TL. [Children's indoor environment. A study of Norwegian dwellings]. Tidsskr Nor Laegeforen 1995; 115:2048-51. [PMID: 7644981] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The indoor environment was investigated in 112 Norwegian dwellings where either healthy children or children with asthma were living. Compared with the official guidelines for indoor air quality, more than 50% of the children's rooms had unacceptable indoor air. Continuous monitoring of carbon dioxide showed unacceptably high levels in 69% of the children's bedrooms at night. Levels of volatile organic compounds exceeded the guideline in 53% of the dwellings. More than 60% of the children were exposed to environmental tobacco smoke, as identified by nicotine in hair and cotinine in urine samples. Levels of house dust mites in excess of the guideline were found in 45% of the dwellings. The results indicated a need to improve the indoor environment in the homes of children.
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Affiliation(s)
- K Aas
- Forskningsinstitutt for pediatrisk allergologi, lungemedisin og miljø Voksentoppen, Oslo
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37
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Costil J, Cloup M, Leclerc F, Devictor D, Beaufils F, Siméoni U, Berthier JC, Berner M, Teyssier G, Rousselot JM. Acute respiratory distress syndrome (ARDS) in children: Multicenter Collaborative Study of the French Group of Pediatric Intensive Care. Pediatr Pulmonol Suppl 1995; 11:106-7. [PMID: 7547318 DOI: 10.1002/ppul.1950191152] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J Costil
- Service de Réanimation Pédiatrique, Hôpital Armond-Trousseau, Paris, France
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38
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Beghetti M, Habre W, Friedli B, Berner M. Continuous low dose inhaled nitric oxide for treatment of severe pulmonary hypertension after cardiac surgery in paediatric patients. Br Heart J 1995; 73:65-8. [PMID: 7888265 PMCID: PMC483758 DOI: 10.1136/hrt.73.1.65] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the effect of inhaled nitric oxide (NO) on severe postoperative pulmonary hypertension in children after surgical repair of a congenital heart defect. DESIGN A pilot study of NO administration to 7 consecutive children who required adrenergic support and in whom postoperative mean pulmonary artery pressure was more than two thirds of mean systemic pressure and persisted despite alkalotic hyperventilation. SETTING Routine care after cardiac surgery for congenital heart disease in a multidisciplinary paediatric intensive care unit. METHODS Continuous inhalation of NO, initially at 15 ppm. Therefore, daily attempts at complete weaning or at reducing NO to the lowest effective dose. RESULTS In 6 of the 7 children NO inhalation selectively decreased mean (SD) pulmonary artery pressure from 51 (12) to 31 (9) mm Hg (P < 0.05) while mean systemic arterial pressure was unchanged (68 (10) v 71 (7) mm Hg) (NS) and the arteriovenous difference in oxygen content decreased from 6.7 (0.9) to 4.8 (0.8) vol% (P < 0.05). Concomitantly PaO2 increased from 158 (98) to 231 (79) mm Hg) (P < 0.05). The seventh child showed no response to NO up to 80 ppm, could not be weaned from cardiopulmonary bypass, and died in the operating room. In responders, attempts at early weaning from NO inhalation always failed and NO at concentrations of less than 10 ppm was continuously administered for a median of 9.5 days (range 4 to 16 days) until complete weaning was possible from a mean dose of 3.9 (2.9) ppm. Methaemoglobinaemia remained below 2% and nitrogen dioxide concentrations usually ranged from 0.1 to 0.2 ppm. One child later died and five were discharged. A few months after surgery Doppler echocardiography (and catheterisation in one) showed evidence of regression of pulmonary hypertension in all 5. CONCLUSIONS Inhalation of NO reduced pulmonary artery pressure in children with severe pulmonary hypertension after cardiac surgery and this effect was maintained over several days at concentrations carrying little risk of toxicity.
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Affiliation(s)
- M Beghetti
- Department of Paediatrics, Hôpital Cantonal Universitaire, Geneva, Switzerland
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39
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Mentha G, Giostra E, Morel P, Le Coultre C, Belli D, Huber O, Romand J, Berner M, Klopfenstein C, Rouge JC. [Results of liver transplantations in Geneva or 32 consecutive transplantations without mortality in 2 years]. Schweiz Med Wochenschr 1994; 124:2131-8. [PMID: 7992028] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Between 1 january 1992 and 31 december 1993, 32 liver transplantations were performed in 29 patients (5 transplants in 3 children and 27 transplants in 26 adults) at Geneva University Hospital. Despite 5 super-urgent transplantations (3 fulminant hepatitis, 1 end-stage Wilson disease and 1 primary nonfunction), all patients are still alive and all have lived more than 10 months. On 1 october 1994, all patients were at home and 93% were in good general condition. No patient of this series had been transplanted for cancer and all patients positive for hepatitis B surface antigen receive long-term administration of anti-HBs immune globulin: in this respect, the long-term mortality risk of the present series of patients seems to be very low. Although these results highlight that liver transplantation can be performed safely by a competent medico-surgical team, two significant difficulties have to be outlined. First, patients are likely to die on the waiting list due to unavailable grafts, especially in emergency cases. Second, the postoperative period of patients with decompensated end-stage liver disease at the time of liver transplantation is still one of high morbidity. These facts underline that chronic liver disease patient should be evaluated for liver transplantation prior to the terminal decompensated stage of the disease, when the candidate's invariably poor general condition precludes successful liver transplantation.
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Affiliation(s)
- G Mentha
- Département de chirurgie, Hôpital cantonal universitaire, Genève
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40
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Bugmann P, Rouge JC, Berner M, Friedli B, Le Coultre C. Use of Gianturco Z stents in the treatment of vascular compression of the tracheobronchial tree in childhood. A feasible solution when surgery fails. Chest 1994; 106:1580-2. [PMID: 7956423 DOI: 10.1378/chest.106.5.1580] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [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: 01/28/2023] Open
Abstract
Severe tracheomalacia secondary to extrinsic vascular compression following a switch operation for transposition is reported. Two attempts at surgical correction failed but successful treatment has been achieved by implantation of two endobronchial Gianturco Z stents. Nonabsorbable stenting in children should be used only in severe obstruction as a last resource, but this technique proved to be feasible in a child weighing 6.2 kg.
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Affiliation(s)
- P Bugmann
- Clinique de Chirurgie Pédiatrique, Hôpital des Enfants, Geneva, Switzerland
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41
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Suter M, Berner M, Vandoni R, Cuttat JF. [Thoracoscopic treatment of recurrent pneumothorax]. Helv Chir Acta 1994; 60:465-470. [PMID: 8034519] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmonary disease with emphysema. A new form of secondary PNO has emerged in the recent years in AIDS patients with pneumocystis carinii pneumonia. We have shifted to a thoracoscopic therapy of PNO since May 1991. 25 PNO in 24 patients (1 bilateral) have been treated since that time up to April 1993. 19 PNO were primary, whereas 6 were secondary, included 3 iatrogenic PNO. Resection of the leaking parenchymal area was performed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrate or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO and had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its resection as well as apical parietal pleurectomy are necessary to obtain good results and a low recurrence rate.
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Affiliation(s)
- M Suter
- Service de chirurgie générale, CHUV, Lausanne
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42
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Gasche Y, Unger PF, Berner M, Roduit C, Jolliet P, Chevrolet JC. [Are infant resistant to carbon monoxide poisoning?]. Schweiz Med Wochenschr 1993; 123:2413-7. [PMID: 8290934] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 20 year old woman and her 13 weeks old infant were found in the same place close together in a house fire. As soon as possible, on-the-spot treatment was initiated simultaneously for both victims, i.e. oxygen (100% FIO2), using endotracheal intubation and mechanical ventilation for the mother, with hyperbaric oxygen when in the hospital, and by facial mask for the baby. On admission (35 minutes after discovery in the fire), the mother remained comatose, whereas the baby showed only moderate neurologic abnormalities. The initial laboratory assessment showed a pH of 7.12 for the mother and 7.06 for the baby.
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Affiliation(s)
- Y Gasche
- Hôpital cantonal universitaire de Genève
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43
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Affiliation(s)
- M Berner
- Unité de Soins Intensifs, Hôpital Cantonal Universitaire, Geneva, Switzerland
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44
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Berner M. [Digestive carcinoids and synchronous malignant tumors]. Helv Chir Acta 1993; 59:757-66. [PMID: 8376137] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
270 digestive carcinoid tumors have been diagnosed at the Pathology Institute of Lausanne between 1971 and 1990; of these 21 were associated with other, synchronous, tumors: 7 of the carcinoids were from the appendix (33%), 8 from the small bowel (38%), 4 were from the colorectum (25%), one from the duodenum (4.5%) and finally one from the stomach (4.5%). Two thirds (14) were associated with adenocarcinomas of the colon, the rest with 2 gastric tumors, 1 tumor of the appendix, 1 of the gallbladder, 1 of the small gut, 1 of the duodenum and 1 of the peritoneum. The mean age of the patients was 70 years, which correlates with the large proportion of carcinomas of the colon. The males (16) clearly outnumbered the females (5) for no obvious reason. 80% of the carcinoids were discovered during the treatment of the associated tumor. Survival was directly related to the stage and aggressivity of the malignant tumor. The carcinoid itself hardly changed the prognosis, except for one case of liver failure due to metastases from carcinoid of the stomach associated with an adenocarcinoma. The histologic features of the carcinoid tumors were unexceptional. Different hypotheses to explain the associations are formulated.
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Affiliation(s)
- M Berner
- Service de chirurgie, CHUV, Lausanne
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45
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Berner M. [Digestive system carcinoid tumor and synchronous malignant tumors]. Schweiz Med Wochenschr 1993; 123:594-9. [PMID: 8480156] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
270 digestive carcinoid tumors have been diagnosed at the Pathology Institute of Lausanne between 1971 and 1990; of these 21 were associated with other, synchronous, tumors: 7 of the carcinoids were from the appendix (33%), 8 from the small bowel (38%), 4 were from the colorectum (25%), one from the duodenum (4.5%) and finally one from the stomach (4.5%). Two thirds (14) were associated with adenocarcinomas of the colon, the rest with 2 gastric tumors, 1 tumor of the appendix, 1 of the gallbladder, 1 of the small gut, 1 of the duodenum and 1 of the peritoneum. The mean age of the patients was 70 years, which correlates with the large proportion of carcinomas of the colon. The males (16) clearly outnumbered the females (5) for no obvious reason. 80% of the carcinoids were discovered during the treatment of the associated tumor. Survival was directly related to the stage and aggressivity of the malignant tumor. The carcinoid itself hardly changed the prognosis, except for one case of liver failure due to metastases from carcinoid of the stomach associated with an adenocarcinoma. The histologic features of the carcinoid tumors were unexceptional. Different hypotheses to explain the associations are formulated.
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Affiliation(s)
- M Berner
- Service de chirurgie, CHUV, Lausanne
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46
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Berner M, Beghetti M, Ricou B, Rouge JC, Prêtre R, Friedli B. Relief of severe pulmonary hypertension after closure of a large ventricular septal defect using low dose inhaled nitric oxide. Intensive Care Med 1993; 19:75-7. [PMID: 8486873 DOI: 10.1007/bf01708365] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [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: 01/31/2023]
Abstract
A 16-month-old girl developed severe pulmonary hypertension after closure of a large ventricular septal defect. All conventional therapeutic measures failed; an attempt to add nitric oxide at a continuous low dose to the inspired gas allowed resolution of pulmonary hypertension and low cardiac output. This report documents that continuous inhalation of low dose nitric oxide is capable of selective resolution of pulmonary hypertension following cardiac surgery for a large septal defect in a child. This suggests that a transient dysfunction in the release of nitric oxide by the pulmonary endothelial cell is responsible for the vasoconstriction.
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Affiliation(s)
- M Berner
- Unité de Soins Intensifs, Clinique de Pédiatrie, Genève, Switzerland
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Dominguez-Roldan JM, Murillo-Cabezas F, Munoz-Sanchez A, Maestre A, Porras F, Santamaria-Mifsut JL, Facco E, Munari M, Baratto F, Behr AU, Bruno R, Giron GP, Sonnet ML, Perrot D, Floret D, Guillaume C, Bui-Xuan B, Vedrinne JM, Motin J, Dall’Acqua G, Cesaro S, Giacomini M, Allaouchiche B, Moulaire V, Bouffard Y, Latronico N, Fenzi F, Guarneri B, Tomelleri G, Tonin P, Rizzuto N, Candiani A, Lacguaniti LG, Irone M, Zamperetti N, Gulino A, Pellegrin C, Dan M, Sandroni C, Bareili A, Piazza O, Della Corte F, Kovacs A, Cucurachi M, Sab JM, Sirodot M, Straboni JP, Dorez D, Dubols JM, Gaussorgues P, Robert D, Delafosse B, Kopp N, Faure JL, Neidecker J, Parma A, Marzorati S, Rampini PM, Egidi M, Calappi E, Massci R, Montolivo M, Gemma M, Regi B, Fiacchino F, Montero JG, Leyba CO, Osuna JM, Jimenez JJ, Noval RL, Hernandez PC, Gervaix A, Beghetti M, Berner M, Schneider A, Rilliet B, Berré J, De Backer D, Moraine JJ, Vincent JL, Kahn RJ, Latour J, Reig A, Ribera D, Alemañ MC, Basco JL, López M, Pastor M, Carrasco F, Zaplana J, Ruiz MR, Sánchez M, Boillot A, Capellier G, Balvay P, Cordier A, Tissot M, Barale F, Bricchi M, Franceschetti S. Neurology. Intensive Care Med 1992. [DOI: 10.1007/bf03216367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Berner M, Cirafici L, Merlini M. [Esophagogastroduodenoscpy by the surgeon]. Helv Chir Acta 1992; 58:779-82. [PMID: 1644593] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In 1990, 123 gastroscopies were performed by surgeons in the Department of Surgery, General Hospital, La Chaux-de-Fonds, Switzerland. Seventy-five percent of these procedures were done on a diagnostic basis and twenty-five percent were controls. Endoscopy includes diagnostic, therapeutic and control procedures of numerous surgical diseases. It is thus important for the general surgeon to be committed in the endoscopic management of these pathologies. Furthermore, preoperative gastroscopy can influence or modify the operative technique. By his nearly inborn knowledge of anatomy, tissue consistency and texture, the surgeon has a priceless advantage to learn, practice and teach endoscopy. Therefore, teaching programs in surgical endoscopy should be widely created and developed in university and teaching hospitals to allow young surgeons a systematic and progressive training during their residency.
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Affiliation(s)
- M Berner
- Département de chirurgie, Hôpital, La Chaux-de-Fonds
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Berner M. [The early bronze age graveyards of Franzhausen I, lower Austria. 2. Demographic analysis]. Anthropol Anz 1992; 50:13-26. [PMID: 1637144] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a recent study of 714 graves of the Early Bronze Age cemetery, Franzhausen I, 658 individuals were demographically analysed. The masculinity rate and the mortality rate in the age groups were of similar order compared with estimates derived from other series of this period. On the base of a stationary population model, life tables were calculated showing life expectancy at birth to be 25.8 years and at the age of 20, 17.7 years. Also computed were: the crude death rate (Z = 38.8); and the population size (P = 31 or 65). The lack of infants were estimated by regressions (5q0 = 58%) and the results are discussed.
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Affiliation(s)
- M Berner
- Anthropologische Abteilung, Naturhistorischen Museums, Wien
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Abstract
The hemodynamic effects of amrinone were assessed in seven children following cardiac surgery. Amrinone was administered as a bolus of 1 mg kg-1 body wt., followed by continuous infusion at 10 micrograms kg-1 min-1 for 1 h and two stepwise increases to 20 and 40 micrograms kg-1 min-1 for 30 min each. Hemodynamic data were obtained and plasma concentrations of amrinone measured 1 h after the bolus dose and immediately before each increment of the infusion rate. Amrinone levels ranged from 0.7 to 2.3 mg l-1. Administration of amrinone lowered systemic vascular resistance from 20.0 +/- 4.3 to 16.5 +/- 4.6 mmHg l-1 min-1 m-2 (p less than 0.05) and reduced mean arterial pressure from 71.7 +/- 9.5 to 62.6 +/- 13.5 mmHg (p less than 0.05) at the highest infusion rate, confirming the known vasodilative effect of the drug. However, these effects did not result in a statistically significant increase in stroke volume (35.0 +/- 7.5 to 35.5 +/- 7.0 ml m-2, NS) or cardiac index (3.10 +/- 0.50 to 3.20 +/- 0.40 l min-1 m-2). One additional patient, in whom a higher loading dose was tried in order to achieve a higher plasma concentration, developed systemic hypotension. A correlation was established between the plasma concentrations of amrinone and the percentage decrease in systemic resistance (r = 0.70, p less than 0.05). These results suggest that in children after open heart surgery, amrinone acts primarily as a systemic vasodilator, with questionable inotropic effect. Accordingly, its use should be restricted to children with severe cardiac failure and documented highly elevated afterload.
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Affiliation(s)
- M Berner
- Clinique Universitaire de Pediatrie, Geneva, Switzerland
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