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Biomedical subjects

H Bucher

Publications and source records attributed to H Bucher.

At least 19 recordsLinked to original sources
PubMed2005

Primary stenting versus primary balloon angioplasty for treating acute myocardial infarction.

BACKGROUND: Balloon angioplasty following myocardial infarction (MI) reduces death, non-fatal MI and stroke compared to thrombolytic reperfusion. However up to 50% of patients experience restenosis and 3% to 5% recurrent myocardial infarction. Therefore, primary stenting may offer additional benefits compared to balloon angioplasty in patients with acute myocardial infarction. OBJECTIVES: To examine whether primary stenting compared to primary balloon angioplasty reduces clinical outcomes in patients with acute myocardial infarction. SEARCH STRATEGY: We searched MEDLINE, EMBASE, Pascal, Index medicus and The Cochrane Controlled Trials Register (The Cochrane Library) from 1979 to March 2002. SELECTION CRITERIA: Randomised controlled trials of primary stenting or balloon angioplasty prior to the invasive procedure; intervention in native coronary arteries within 24 hours after onset of symptoms of myocardial infarction; report of death or reinfarction; and follow-up of at least 1 month. Trials were excluded when randomisation occurred after an invasive procedure and if they exclusively included patients with cardiogenic shock. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected and extracted data from identified trials. Outcomes included mortality, reinfarction, coronary artery bypass grafting, target vessel revascularization, need for vascular repair or blood transfusion. Peto odds ratios were calculated. To explore the stability of the overall treatment effect various sensitivity analyses were performed. MAIN RESULTS: We included nine trials of 4433 participants. Odds ratios for mortality after stenting compared to balloon angioplasty at 30 days, 6 and 12 months were 1.16 (95% CI 0.78 to 1.73), 1.27 (95% CI 0.89 to 1.83), and 1.06 (95% CI 0.77 to 1.45). At 30 days, 6 and 12 months odds ratios for reinfarction after stenting compared to balloon angioplasty were 0.52 (95% CI 0.31 to 0.87), 0.67 (95% CI 0.45 to 1.00), and 0.67 (95% CI 0.45-0.98) and odds ratio for target vessel revascularization after stenting compared to balloon angioplasty were 0.45 (95%CI 0.34 to 0.60), 0.42 (95% CI 0.35 to 0.51), and 0.47 (95% CI 0.38 to 0.57). The odds ratio for post-interventional bleeding complications after stenting compared to balloon angioplasty was 1.34 (95% CI 0.95 to 1.88; test of heterogeneity p > 0.1). AUTHORS' CONCLUSIONS: There is no evidence to suggest that primary stenting reduces mortality when compared to balloon angioplasty. Stenting seems to be associated with a reduced risk of reinfarction and target vessel revascularization, but potential confounding due to unbalanced post-interventional antithrombotic/anticoagulant therapies can not be ruled out on basis of this review.

Angioplasty, Balloon, Coronary↗
PubMed2001

Disseminated M. avium complex infection in the Swiss HIV Cohort Study: declining incidence, improved prognosis and discontinuation of maintenance therapy.

BACKGROUND: Introduction of potent antiretroviral combination therapy (ART) has reduced overall morbidity and mortality amongst HIV-infected adults. Some prophylactic regimes against opportunistic infections can be discontinued in patients under successful ART. QUESTIONS UNDER STUDY: (1) The influence of the availability of ART on incidence and mortality of disseminated M. avium Complex infection (MAC). (2) The safety of discontinuation of maintenance therapy against MAC in patients on ART. SETTING: The Swiss HIV-Cohort Study, a prospective multicentre study of HIV-infected adults. METHODS: Patients with a nadir CD4 count below 50 cells/mm3 were considered at risk for MAC and contributed to total follow-up time for calculating the incidence. Survival analysis was performed by using Kaplan Meier and Cox proportional hazards methods. Safety of discontinuation of maintenance therapy was evaluated by review of the medical notes. RESULTS: 398 patients were diagnosed with MAC from 1990 to 1999. 350 had a previous CD4 count below 50 cells/mm3. A total of 3208 patients had a nadir CD4 count of less than 50 cells/mm3 during the study period and contributed to a total follow-up of 6004 person-years. The incidence over the whole study period was 5.8 events per 100 person-years. In the time period of available ART the incidence of MAC was significantly reduced (1.4 versus 8.8 events per 100 person-years, p < 0.001). Being diagnosed after 1995 was the most powerful predictor of better survival (adjusted hazard ratio for death: 0.27; p < 0.001). None of 24 patients discontinuing maintenance therapy while on ART experienced recurrence of MAC during a total follow-up of 56.6 person-years (upper 95% confidence limit 5.3 per 100 person-years). CONCLUSION: Introducing ART has markedly reduced the risk of MAC for HIV-infected individuals with a history of very low CD4 counts. Survival after diagnosis of MAC has improved after ART became available. In patients responding to ART, discontinuation of maintenance therapy against M. avium may be safe.

AIDS-Related Opportunistic Infections↗
PubMed2001

Discontinuation of primary prophylaxis in HIV-infected patients at high risk of Pneumocystis carinii pneumonia: prospective multicentre study.

OBJECTIVES: To assess the safety of discontinuation of primary prophylaxis in HIV-infected patients on antiretroviral combination therapy at high risk of developing Pneumocystis carinii pneumonia. DESIGN: Prospective multicentre study. PATIENTS AND METHODS: The incidence of P. carinii pneumonia after discontinuation of primary prophylaxis was studied in 396 HIV-infected patients on antiretroviral combination therapy who experienced an increase in their CD4 cell count to at least 200 x 10(6)/l and 14% of total lymphocytes; the study population included 191 patients with a history of CD4 cell counts below 100 x 10(6)/l (245 person-years) and 144 patients with plasma HIV RNA above 200 copies/ml (215 person-years). RESULTS: There was one case of Pneumocystis pneumonia, an incidence of 0.18 per 100 person-years [95% confidence interval (CI), 0.005--1.0 per 100 person-years]. No case was diagnosed in groups with low nadir CD4 cell counts (95% CI, 0--1.2 per 100 person-years) or detectable plasma HIV RNA (95% CI, 0--1.4 per 100 person-years). CONCLUSIONS: Discontinuation of primary prophylaxis against Pneumocystis pneumonia is safe in patients who have responded with a sustained increase in their CD4 cell count to antiretroviral combination therapy, irrespective of the CD4 cell count nadir and the viral load at the time of stopping prophylaxis.

Adult↗
PubMed2001

Grades of recommendation for antithrombotic agents.

The strength of any recommendation depends on two factors: the trade-off between benefits and risks, and the strength of the methodology that leads us to estimates of the treatment effect. The framework that we used for this conference captures these factors. We grade the trade-off between benefits and risks in two categories: (1) the trade-off is clear enough that most patients, despite differences in values, would make the same choice; and (2) the trade-off is less clear, and each patient's values will likely lead to different choices. We grade methodologic strength in three categories: (1) randomized trials, ideally summarized in a meta-analysis, that show consistent results; (2) randomized trials with inconsistent results; and (3)observational studies. The framework summarized in Table 1 therefore generates recommendations from the very strong (1A: benefit/risk clear, methods strong) to the very weak (2C: benefit/risk questionable, methods weak). Whatever the grade of recommendation, clinicians must bring their judgment considering local and individual patient circumstances, and patient values, to bear in making individual decisions. In general, however, they should place progressively greater weight on expert recommendations as they move from 2C to 1A.

Fibrinolytic Agents↗
PubMed1999

Impaired chemical coupling of cerebral blood flow is compatible with intact neurological outcome in neonates with perinatal risk factors.

Early detection of pathophysiological factors associated with permanent brain damage is a major issue in neonatal medicine. The aim of our study was to evaluate the significance of the CO2 reactivity of cerebral blood flow (CBF) in neonates with perinatal risk factors. Fourteen ventilated neonates with perinatal risk factors (pathological cardiotocogramm, low cord pH, postpartal encephalopathy) were enrolled into this prospective study. The study was performed 18-123 h after birth. CBF was measured using the noninvasive intravenous 133Xe method. Two measurements were taken with a minimal PaCO2-difference of 5 mm Hg. From the two CBF values the CO2 reactivity was calculated. Outcome was evaluated 1 year after birth. The CBF values at a lower PaCO2 ranged from 6.6 to 115. 2 ml/100 g brain issue/min (median = 18.2) and at a higher PaCO2 level from 7.1 to 125.7 ml/100 g brain tissue/min (median = 18.75). The calculated CO2 reactivity ranged from -9.6 to 6.6% (median 1.1%) change in CBF/mm Hg change in PaCO2. CO2 reactivity correlated with lowest pH (r2 = 0.35, p = 0.02). Two infants died, one of neonatal sepsis, the other of heart failure. Neurological outcome at the age of 1 year was normal in 11 patients, 1 had severe cerebral palsy. From the 12 surviving patients the patient with severe neurological deficit showed the highest CBF values (125.7 ml/100 g/min). Impaired chemical coupling of cerebral blood flow is compatible with intact neurological outcome in neonates with perinatal risk factors. CO2 reactivity in these newborns correlates with the lowest pH and may reflect the severity of perinatal asphyxia.

Blood Flow Velocity↗
PubMed1999

CO2 reactivity of the cerebral hemoglobin concentration in healthy term newborns measured by near infrared spectrophotometry.

CO2 reactivity of cerebral hemoglobin concentration was studied in 16 healthy term neonates on days 1 and 4 after birth using the near infrared spectrophotometry (NIRS) technique. The aim was to establish data on the physiological range of CO2 reactivity in healthy newborns and to investigate the influence of postnatal age on it. The CO2 reactivity measured by NIRS is expressed as the change of the total cerebral hemoglobin concentration (tHbR) per change of CO2 tension in micromol/l/kPa. We evaluated CO2 reactivity during increases and decreases of transcutaneous CO2 partial pressure and found in our methodological setting the data of the increases more reliable. In all infants but 1 we found a tHbR on day 1 with a mean value of 8.19 micromol/l/kPa (-1.39 to 18.87), in all infants on day 4 with a mean value of 9.54 micromol/l/kPa (2.76-25. 88). There is a trend to higher values between day 1 and day 4 (difference = 2.25 micromol/l/kPa; p = 0.08). The noninvasive NIRS technique enabled us to test the cerebrovascular CO2 reactivity of the tHbR for the first time in healthy term newborns. Data on its physiologic range and variability are presented and compared to findings from ventilated infants and other age groups. As the CO2 reactivity might be an indicator for infants at risk of cerebral damage, it is necessary to have data on the physiological range of this parameter.

Brain↗
PubMed1998

Didanosine plus stavudine with or without hydroxyurea in HIV-1-infected patients: 1 year follow-up. Swiss HIV Cohort Study.

A total of 144 human immunodeficiency virus (HIV)-infected patients (mean CD4 cell count, 367 cells/mm3) were included in a double-blind placebo-controlled trial testing the efficacy on surrogate markers of HIV progression of the combination didanosine (2',3'-dideoxyinosine or DDI) plus stavudine (2',3'-didehydro-2',3'-dideoxythymidine or D4T) with or without hydroxyurea. The primary end point was a reduction of HIV RNA levels to below 200 copies/ml after 12 weeks of treatment. The results showed that the triple combination was associated with a more profound decrease in HIV RNA with an increased proportion of patients with viraemia < 200 copies/ml. This effect persisted for the majority of the patients after a 48 week follow-up. In contrast, the increase in CD4 cell counts was less in patients treated with hydroxyurea because of lymphopenia, and adverse events were more frequent in hydroxyurea-treated patients. In conclusion, the addition of hydroxyurea consistently improved the antiviral activity of the didanosine/stavudine combination over a 48 week follow-up. Increased toxicity and decreased effect on CD4 cell counts might inspire caution.

Anti-HIV Agents↗
PubMed1997

Eosinophilia in patients infected with the human immunodeficiency virus.

The prevalence and significance of peripheral blood eosinophilia in patients infected with the human immunodeficiency virus (HIV) were evaluated. Fifteen of 119 consecutive patients had absolute eosinophil counts of > 450/mm3. During a mean follow-up period of 419 days eosinophilia could be identified as secondary to a parasitic infection in only one patient. Correlation with disease stage showed a higher rate of advanced disease in patients with absolute eosinophilia. In a multivariate regression analysis, only low CD4+ cell counts, not the CDC disease stage or the use of antiretroviral therapy or primary prophylaxis, contributed significantly to the prevalence of eosinophilia. It is concluded that expensive laboratory investigations in asymptomatic patients with advanced-stage HIV disease are neither necessary nor cost effective.

Adult↗
PubMed1997

Marked changes of lipid levels during puberty in a patient with lipoprotein lipase deficiency.

UNLABELLED: Clinical and biochemical characteristics of a female patient with familial lipoprotein lipase deficiency have been followed in short intervals before and during puberty. The proband is compound heterozygote for two missense mutations in the lipoprotein lipase gene. One mutation occurs in codon 250 (Asp250-->Asn), the other is in codon 410 (Glu410-->Lys). The residual lipoprotein lipase activity in the proband is less than 10% of controls. Before puberty the proband usually presented with moderate isolated hypertriglyceridaemia. During the initial phase of puberty a dramatic increase in the plasma concentration of both cholesterol and triglycerides was observed. During the second half of puberty a reduction of cholesterol but not of triglycerides was noticed. CONCLUSION: These findings show that the phenotypic expression of familial chylomicronaemia can be modified to a large extent by hormones. Furthermore they demonstrate the need for a closer clinical observation of type I patients during puberty.

Adolescent↗
PubMed1996

Optimising the methodology of calculating the cerebral blood flow of newborn infants from near infra-red spectrophotometry data.

Cerebral blood flow can be measured in neonates by near infra-red spectrophotometry. The tracer is oxyhaemoglobin. The purpose of the study is to compare the test-retest variability of two previously proposed methods (UCH and COP) of analysis, and to investigate the influence of sampling rates, smoothing and integration periods. Under clinical conditions good measurements are often difficult to obtain. Therefore, a second goal is to find ways of determining the quality of individual measurements. 380 cerebral blood flow measurements from 69 infants are analysed. The data set is optimised statistically for the lowest test-retest variability and the following results are obtained. The test-retest variability of measurements at 2 s sampling time data is considerably worse than at 0.5 s sampling time. Smoothing does not change the test retest variability. A 6 s integration period gives higher values and higher test-retest variability than an 8 s integration period. By applying the suggested criteria, a test-retest variability of 17% is achieved, if 50% of the measurements are rejected. The mean cerebral blood flow is 12.2 ml (100 g)-1 min-1 for the UCH method and 9.7 ml [corrected] (100 g)-1 min-1 for the COP method. The test-retest variability of both methods is comparable for 0.5 s sampling time. For 2 s sampling time the method proposed by Skov et al. is significantly better. These test retest variabilities represent maximum values, part of the observed variability may be due to physiological changes of unknown magnitude.

Cerebrovascular Circulation↗
PubMed1994

[Compliance of asylum seekers with an expanded border health screening program in the Basel-Stadt canton 1992-1993].

In 1992, the Swiss Public Health Office introduced an expanded tuberculosis screening program for refugees. In addition to routine chest X-rays, it includes tuberculosis skin testing and prophylactic treatment with isoniazid of skin test positive individuals. In addition, a vaccine program has been established which, besides routine hepatitis B vaccination of anti-HBc negative individuals, includes vaccination of all refugees against tetanus, diphtheria, polio, measles, mumps and rubella. The two-year experience of this expanded program is reported from Canton Basel-Stadt, Switzerland. During the two-year period (1992 to 1993), 289 adults and 53 children were screened. In 3.1% (n = 9) of 289 refugees who were examined by X-ray, smear positive tuberculosis was found. These 9 cases contributed 12% of all tuberculosis cases identified in Canton Basel-Stadt during the observation period. In 4.4% of all refugees prophylactic treatment with isoniazid was initiated, but 7 of the 15 cases (46.6%) did not complete the prophylaxis. In contrast, compliance with the vaccine program was better and complete vaccination was achieved in 90% of all refugees. The prevalence of anti-HBc antibodies was 28.7% and highest among refugees from Turkey (48.6%) and Africa (34.2%). X-ray screening for tuberculosis in high risk populations such as refugees is effective. However, compliance with 6 months' prophylactic treatment with isoniazid for skin test positives was only moderate.

Adolescent↗
PubMed1994

[Demographic aging in Germany and the need for care in private households: a regional perspective].

"In the Federal Republic of Germany there are regional differences in the ageing process. As a result the increase of people needing care and attention differs regionally, too. The authors deal with the following questions: Which particular regions will be most affected by the ageing process and to which extent? How is the proportion of people needing care and those providing it in private households affected by this? To which extent can private households cope with the demands of nursing elderly people at home?" The focus is on the period 1992 to 2010. (SUMMARY IN ENG)

Demography↗
PubMed1994

[Smoking and smoking weaning].

Stop-smoking counselling is a challenging task in primary health care, its efficacy being often underestimated by the physician. Health care physicians are not very inclined to advise their smoking patients to stop smoking and give specific counselling. This is in contradiction with the expectations of more than two thirds of the smoking patients, who expect their physicians to help them. The present article discusses the therapeutical methods for stop-smoking counselling in primary health care. In particular, the article illustrates the importance for this support (including the possibilities for nicotin substitution in the weaning stage).

Counseling↗
PubMed1993

[Social class and cardiovascular risk factors in Italian-speaking Switzerland: results of the first Swiss population study MONIKA Project 1985-1986].

The relationship of social class and prevalence of risk factors for cardiovascular diseases was investigated within the Swiss MONICA-project, a cross sectional study of the Swiss-Italian population started in 1985/1986. A representative sample of 984 men and 1014 women ages 35 to 64 was selected, the response rate was 78%. Social class was measured by two indicators, occupational status and education. A significant trend was found in age standardized analysis with higher mean blood pressure and body mass index in lower social classes (p < 0.001). When other confounders for cardiovascular diseases were considered in a multiple regression model, the predictive power of social class was moderate. A significant inverse relationship of cardiovascular risk factors and social class was only found for body mass index (both sexes) and exercise in women which was directly related to higher social class and education. No relationship was found for lipids (cholesterol, HDL-cholesterol), blood pressure and smoking in both sexes. Risk factors for cardiovascular diseases beside obesity do not seem to cluster in lower social classes within the Swiss-Italian population.

Adult↗
PubMed1990

[Smoking cessation in general practice].

Health problems and diseases related to smoking are common problems in primary health care. However, primary health care physicians are less inclined to advise their smoking patients to stop smoking and give specific counselling. This is in contrast with the expectations of the smoking patients who expect their physicians to do so. An introduction to behavior modification for smoking cessation in primary health care is given. Factors linked to successful cessation are shown, as indication for nicotine substitution in the weaning stage is discussed. Stop smoking counselling is a challenging task in primary health care, its efficacy being often underestimated by the physician.

Combined Modality Therapy↗