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H Neuenschwander

Publications and source records attributed to H Neuenschwander.

At least 19 recordsLinked to original sources
PubMed2004

[Fatigue].

Fatigue is a highly prevalent symptom in cancer patients. However in the daily practice this issue doesn't get adequate attention, because of limited therapeutic tools. A number of research issues in this field has been started during the last few years. Some of these new findings will soon modify and improve treatment options. In the meantime it is worthwhile to identify etiologic factors. Some of them might be treated with a reasonable cost/benefit ratio, aiming to improve function and therefore the health related quality of life.

Diagnosis, Differential↗
PubMed2004

Lessons from an Ukrainian woman with clubbing and back pain.

We present this case that we consider of particular interest in palliative care because of the difficulty we encountered in palliating the patient's symptoms. The difficulties derived, at least in part, from particular personality traits and complex social circumstances. We think this case is an excellent example to demonstrate the complexity of the process of pain and the different resources and techniques that can be used to manage it. We also wish to underline the importance of clinical signs in diagnosis. In fact, this patient showed signs compatible with Pierre-Marie disease (or pulmonary hypertrophic osteoarthropathy, HOA). Finally, we would like to restate a possible link between neoplastic syndromes and the Chernobyl radiation disaster.

Adult↗
PubMed2001

"Euthanasia": a survey by the Swiss Association for Palliative Care.

Since the Swiss Association for Palliative Care (SAPC) considers itself an important partner in the national debate on euthanasia, the Board decided to conduct a survey among its members. An anonymous questionnaire was sent to the 726 members of the SAPC, consisting of multiple choice questions on positions that might be adopted in different hypothetical scenarios and one open question about the rationale for the answers. The response rate achieved with one mailing was 55.6%. The proportions of the respondents who were opposed to different forms of euthanasia were, in ascending order: 56% opposed to physician-assisted suicide (PAS); 69% to direct active euthanasia (DAE); 75% to DAE for psychiatric patients; 84% to delegation of DAE in the case of incompetent patients; and 90% to life-terminating acts without explicit requests (LAWER). Almost 10% of the members reported personal experiences with PAS and different forms of DAE. The main decisional bases drawn on for the answers were ethical values and the clinical or personal experience of the respondents; however, the same categories of arguments were used both by those opposing and by those favouring DAE. There are important variations among the members of the SAPC in the debate on euthanasia. Individual autonomy seems to be an important underlying concept for the different positions; the categories of arguments cited by opponents and supporters of DAE did not differ.

Adult↗
PubMed1999

[Opiates on the upswing--are there really unproblematic?].

Although morphine is known for almost 200 years as analgesic a considerable resistance is encountered regarding its use and prescription. This may only in part derive from cultural and political reasons mainly, however, from the widespread but usually unfounded fear of side effects. This article tries to put these fears in perspective. Morphine is a hardly toxic drug in the hands of the clinician aware of the side effects and willing to search for them. Possibilities how to avoid side effects and alternatives to morphine are proposed.

Analgesics, Opioid↗
PubMed1998

Palliative care of cancer patients: audit of current hospital procedures.

The palliative care of cancer patients admitted for tumour-related symptoms to three different departments (medical oncology, radiotherapy, internal medicine) of a general hospital was prospectively audited. The physicians directly responsible for the patients provided prospective data by reporting both the diagnostic and therapeutic interventions performed and the degree of control achieved for each symptom. A patient form for evaluation of the control achieved in the case of each symptom by means of linear analogue scales was also provided. The appropriateness of all procedures was evaluated by two external auditors. Over 6 months, 125 such admissions were recorded: 24 patients entered the study and the management of 56 symptoms, the most common of which were pain and dyspnoea, was reviewed. A total of 72 diagnostic procedures were performed, deemed necessary for only 50% of symptoms, optional for 15%, and performed as part of a logical sequence for 38%. A total of 130 therapeutic interventions were undertaken, deemed necessary for 55% of symptoms, optional for 15% and carried out as part of a logical sequence for 44%. Re-evaluations of symptoms and physician and patient evaluations of the degree of control achieved could not be assessed because of lack of information. The audit could not be repeated owing to the low accrual of patients and incompleteness of the data collection. Reasons for failure of the study and proposals for feasible methods of auditing the management of symptoms in cancer patients are discussed.

Adult↗
PubMed1997

Matching the clinical function and symptom status with the expectations of patients with advanced cancer, their families, and health care workers.

Continuous accurate assessment is mandatory for palliative care of good quality. One of the major objectives in palliation is to meet the expectations of patient, family members and care givers. While a number of valid tools for assessing symptoms or function are available, there are unfortunately no recognized instruments for assessing expectations. The mismatch of expectations and the actual situation is a major source of distress and conflict. The present paper describes a simple way of visualizing this distress and conflict graphically. In our experience, this method is helpful in raising awareness of and enabling analysis of distress and conflict in patients, family members, and health care workers. It is also useful in the education of students and members of the palliative care team. It is illustrated with reference to four clinical situations.

Adaptation, Psychological↗
PubMed1997

Dose-dependent reduction of retinal vessel changes associated with diabetic retinopathy in galactose-fed dogs by the aldose reductase inhibitor M79175.

The onset and progression of retinal vascular changes associated with early diabetic retinopathy has been delayed in beagles fed 30% galactose diet for 38 months by treatment with the aldose reductase inhibitor M79175 (2-methyl-6-fluoro-spirochroman-4-5'- imidazolidine-2',4'-dione). Forty 9-month old male beagles were fed a daily diet containing either 30% non-nutrient filler or 30% galactose. One group of galactose-fed dogs was untreated while the others received M79175 at an average group dose of either 10 or 16 mg/kg/day. After 38 months one eye from 4 dogs from each group was enucleated and the isolated retinal vasculatures were objectively evaluated using an Olympus Cue-3 color image analysis system. Measurements of endothelium/pericyte (E/P) ratios, pericyte ghosts/1000 cells, pericytes and endothelial densities, and % acellularity per area and % acellularity per capillary length were conducted on a 0.1 mm square area surrounding the midpoints of 12 previously defined subregions. With the exception of endothelial densities which were not changed in galactose-fed dogs, M79175 treatment resulted in smaller changes in all parameters examined with the E/P ratio in dogs treated with 16 mg/kg/day M79175 not significantly different from that of age-matched non-galactose-fed dogs. These studies indicate that aldose reductase inhibitors provide dose-dependent protection against pericyte degeneration and subsequent microaneurysms formation.

Aldehyde Reductase↗
PubMed1996

The last 3 months of life of cancer patients: medical aspects and role of home-care services in southern Switzerland.

The clinical data on terminal cancer patients who have died since the establishment of a program of collaboration between community services and the cancer center of Canton of Ticino, southern Switzerland, were retrospectively analyzed to describe the characteristics of patients seen and the effect on them of a home-care program coordinated by the cancer center. The home-care program is based on five geographically grouped community-based domiciliary services, with the addition of one nurse responsible for coordination and one physician from the oncology center. Selection criteria for participation in the home-care program are defined. The main outcome measures were: number of hospitalizations and median hospital stay during the last 3 months of life; reasons for and median length of last hospitalization; place of death of patients who had home care and those who did not. In the group of 993 patients analyzed, the median contact time with the cancer center was 9.5 months (10th percentile: 1 month, 90th percentile: 71 months); the most frequent neoplasm was lung cancer (22%) with the briefest contact time (7.5 months; 10th percentile: 1 month; 90th percentile: 21 months); 13.5% of patients were never hospitalized; half of the patients had a total hospital stay of 24 days or longer and 23% died at home. The sociodemographic and medical characteristics of home-care users were similar to those of the home-care non-users and to those of the overall group. In the group of home-care users (32% of the total) 22% were never hospitalized, half of the patients had a total hospital stay of 17 days or longer, and 43.5% of them died at home. These values were significantly different (P > 0.001) from those reported in the group of home-care non-users. Palliative care, provided at home through community-based domiciliary services, is associated with less frequent and shorter hospitalizations in the last 3 months of life. Medical oncology and palliative treatments should be mutually complementary to improve patients care. Cancer centers should be involved in the planning and coordination of supportive-care domiciliary services.

Aged↗
PubMed1996

Guidelines on artificial nutrition versus hydration in terminal cancer patients. European Association for Palliative Care.

Whether a terminally ill cancer patient should be actively fed or simply hydrated through subcutaneous or intravenous infusion of isotonic fluids is a matter of ongoing controversy among clinicians involved in the care of these patients. Under the auspices of the European Association for Palliative Care, a committee of experts developed guidelines to help clinicians make a reasonable decision on what type of nutritional support should be provided on a case-by-case basis. It was acknowledged that part of the controversy related to the definition of the terminal cancer patient, since this is a heterogeneous group of patients with different needs, expectations, and potential for a medical intervention. A major difficulty is the prediction of life expectancy and the patient's likely response to vigorous nutritional support. In an attempt to reach a decision on the type of treatment support (artificial nutrition vs. hydration) which would best meet the needs and expectations of the patient, we propose a three-step process: Step 1: define the eight key elements necessary to reach a decision; Step II: make the decision; and Step III: reevaluate the patient and the proposed treatment at specified intervals. Step I involves assessing the patient concerning the following: 1) oncological/clinical condition; 2) symptoms; 3) expected length of survival; 4) hydration and nutritional status; 5) spontaneous or voluntary nutrient intake; 6) psychological profile; 7) gut function and potential route of administration; and 8) need for special services based on type of nutritional support prescribed. Step II involves the overall assessment of pros and cons, based on information determined in Step I, in order to reach an appropriate decision based on a well-defined end point (i.e., improvement of quality of life; maintaining patient survival; attaining rehydration). Step III involves the periodic reevaluation of the decision made in Step II based on the proposed goal and the attained result.

Fluid Therapy↗
PubMed1995

Hospice--a homecare service for terminally ill cancer patients in southern Switzerland.

We describe the circumstances that led to the building up of a home care service for terminally ill cancer patients in a part of southern Switzerland. We describe the goals, the structure and the functioning of this service as it works in two areas. We give some results of a retrospective study on hospitalization, home care and death at home.

Health Services Research↗
PubMed1995

MMC--a high-performance Monte Carlo code for electron beam treatment planning.

The macro Monte Carlo (MMC) method has been developed to improve the speed of traditional Monte Carlo (MC) high-energy electron transport calculations without loss in accuracy. The MMC algorithm uses results derived from conventional MC simulations of electron transport through macroscopic spheres of various radii and consisting of a variety of media. Based on these results, electrons are transported in macroscopic steps through the absorber. The absorber geometry is represented by a three-dimensional (3D) density matrix, typically derived from computer tomographic (CT) data. Energy lost by the electrons along their paths through the absorber is scored in a 3D dose matrix. Transport of secondary electrons and bremsstrahlung photons is taken into account. Major modifications of the original implementation of the MMC algorithm have resulted in an improved version of the code, resolving earlier problems with electron transport across interfaces of different materials, and running at a substantially higher speed. Furthermore, the code has been integrated into a clinical 3D treatment planning system. MMC results are in good agreement with results from conventional MC codes and are obtained with a speed gain of about one order of magnitude for clinically relevant irradiation situations. Calculation times to obtain a relative statistical accuracy of 2% per dose grid voxel for small electron field sizes are short enough to be routinely useful in radiotherapy clinics on present day affordable workstation computers. Considering speed, accuracy and memory requirements, MMC is a promising alternative to currently available electron dose planning algorithms.

Algorithms↗
PubMed1995

Endothelial changes in galactose-fed dogs.

Specular microscopic studies indicate that the size (polymegathism) and shape (pleomorphism) of the hexagonal corneal endothelial cells change in diabetics. Similar morphometric changes of the corneal endothelium have also been experimentally observed in diabetic rats as well as in diabetic and galactose-fed dogs and concomitant administration of aldose reductase inhibitors reduced these morphological changes. The purpose of this study was to examine whether corneal endothelial changes in galactose-fed dogs are reversible by the marked reduction of galactitol production after stopping prolonged galactose feeding. Ten control dogs were fed a normal diet, while 48 dogs were fed a diet containing 30% galactose. The galactose diet was removed from 15 dogs after 24 months at which time pericyte ghosts in the retina had developed and another 15 dogs were removed from the galactose diet after 31 months when retinal microaneurysms had developed. Eighteen dogs remained on galactose diet throughout the study (38 months). Specular microscopy was conducted on members of all groups after 38 months of study and the photographs were analyzed in masked fashion on the Bambi image analysis system. The evaluation of the corneal endothelial cells revealed significant differences in the cell size and density between galactose-fed dogs in the three groups and normal, age-matched control dogs. Corneal endothelial changes were not significantly reduced in dogs fed galactose for either 24 months or 31 months and then fed a normal diet for 14 and 7 months, respectively, indicating that amelioration of endothelial cell changes requires therapy prior to the advent of endothelial morphologic changes.

Animals↗
PubMed1994

Ondansetron plus dexamethasone is superior to ondansetron alone in the prevention of emesis in chemotherapy-naive and previously treated patients. Swiss Group for Clinical Cancer Research (SAKK).

BACKGROUND: This prospective, randomized, double-blind study assessed whether the addition of dexamethasone to ondansetron leads to improved control of chemotherapy--induced emesis, both in patients undergoing their first course of highly emetogenic chemotherapy and in chemotherapy-pretreated patients refractory to standard anti-emetics. PATIENTS AND METHODS: Patients were randomized to receive either 20 mg dexamethasone as an intravenous infusion or placebo plus ondansetron 8 mg 15 minutes prior to and 4 and 8 hours after the administration of chemotherapy. According to the randomisation code patients received from day 2 to day 5 either ondansetron 8 mg p.o. + placebo p.o., three times daily, or ondansetron 8 mg p.o. + dexamethasone 4 mg p.o., three times daily. Patients undergoing multiple-day treatment received intravenous study treatment on the days of chemotherapy and thereafter oral treatment as outlined above. RESULTS: A total of 215 patients were entered into the study. Of these, 207 were evaluable (111 previously-untreated and 96 previously-treated patients). In the chemotherapy-naive patients the combination of ondansetron plus dexamethasone was significantly superior to ondansetron plus placebo in protecting the patients completely from emesis (retching and vomiting) (81% versus 64%, p = 0.04). The mean number of vomiting episodes was significantly lower in the ondansetron-plus-dexamethasone-treated patients than in those receiving ondansetron plus placebo (0.8 versus 2.1, p = 0.03). In this group of patients there was significantly superior protection from emesis on the second day (p-value = 0.04), and a trend towards a better protection on the third and fourth days. On each day the active combination offered better protection from nausea with an approximately 20% difference in favor of ondansetron plus dexamethasone. In the group of established vomiters the combination of ondansetron plus dexamethansone was superior to ondansetron plus placebo in protecting the patients from acute emesis, with 70% versus 48% of the patients being completely protected (p = 0.03). The mean number of vomiting episodes was significantly lower in the ondansetron-plus-dexamethasone-treated-patients than in those receiving ondansetron plus placebo (0.9 versus 2.1, p = 0.02). In the ondansetron-plus-dexamethasone arm 55% of the patients had complete protection from nausea, retching and vomiting compared to 35% in the ondansetron-plus-placebo-treated group (p = 0.05). Overall 22% of the patients (20% in the ondansetron-plus-placebo and 25% in the ondansetron-plus-dexamethasone arm) experienced at least one, usually mild, adverse event. More patients in the ondansetron-plus-dexamethasone arm complained of epigastric pain or burning (8/101 versus 4/112, p-value = 0.16). The difference in patients reporting constipation (6/101 versus 0/112) was highly significant at a p-value of 0.008. CONCLUSIONS: The combination of dexamethasone plus ondansetron is more effective in protecting chemotherapy-naive patients undergoing their first course of highly emetogenic chemotherapy with cisplatin and chemotherapy-pretreated patients refractory to standard antiemetics from chemotherapy-induced nausea and vomiting compared to ondansetron plus placebo.

Adolescent↗
PubMed1992

A simplified agarose gel electrophoresis for rotavirus detection.

The use of agarose gel electrophoresis for rotavirus detection is a suitable routine method if simplifying modifications are introduced. Incorporation of ethidium bromide into the agarose gel permits its use for several times in the course of one week without further staining of the RNA segments. The electrophoresis chamber with a UV-light-transparent bottom is put directly onto the transilluminator and the RNA bands of the rotavirus can be visualized without manipulating the gel tray. During the winter of 1990/91, we found a good sensitivity (98%) of this method in comparison to a latex agglutination test (Slidex Rota-Kit 2, bio Mérieux).

Child↗
PubMed1990

[Adjuvant systemic therapy in breast carcinoma in the 1990s: status of things and open questions].

Adjuvant systemic therapy of breast cancer has been shown to reduce relapses and prolong survival in the women treated. This is true of all subpopulations studied. Six-month multidrug chemotherapy in premenopausal patients, and tamoxifen or short-term chemotherapy in postmenopausal patients, are the treatments of choice in reducing the risk of relapse. In the near future ongoing research may answer some of the open questions surrounding the definition of populations for which the risk of relapse justifies therapy and the optimum manner of using available therapies. The modest but real improvement in prognosis of operable breast cancer was obtained solely by means of clinical trials. Participation in clinical research programs is becoming medically and socially mandatory.

Adult↗
PubMed1989

[Therapy of metastatic prostatic cancer by orchiectomy plus Anandron versus orchiectomy plus placebo. Initial results of a randomized multicenter study].

In the course of a randomized double blind trial conducted by 7 Swiss urological centres, 51 patients with advanced, not pretreated carcinoma of the prostate were included. Following orchiectomy the patients were either administered 300 mg Anandron daily (Roussel RU 23908) or Placebo. Twelve months later the Anandron-group shows a slightly better objective response whereas there is no difference in survival rates. The adverse effects of Anandron-treatment are described.

Aged↗