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Biomedical subjects

J C Rageth

Publications and source records attributed to J C Rageth.

At least 19 recordsLinked to original sources
PubMed2000

[Measuring patient satisfaction in inpatient gynecology: significant quality improvements].

In the present study a validated questionnaire was used to measure patient satisfaction in a clinic of gynecology in a regional hospital. The goal was to assess problems, to solve them, and to increase patient satisfaction. A 50-item questionnaire was applied to assess satisfaction scores of 60 gynecology patients in 1996, and of 185 patients in 1998/99. The overall degree of patient satisfaction amounted to 74.2 +/- 22.7% increasing two years later to 78.0 +/- 25.8%. This represents a significant improvement and can be considered as success to improve quality. A significant increase of the satisfaction scores was obtained in four domains: 1. Information about the planned intervention, 2. courtesy and willingness to explain the procedures of the anesthesiologists, 3. cleanliness and 4. comfort of room. The present study confirms that validated assessment of patient satisfaction allows to identify problems and to solve them with appropriate corrective measures. This results in an increase of patient satisfaction.

Female↗
PubMed2000

[Postpartum footdrop].

We report on a rare peripartal neuropathy of the leg caused by prolonged difficult labour. Immediately after delivery two patients complained of unilateral footdrop and numbness in the leg. The footdrop was most probably due to compression of the lumbosacral trunk exposed to the foetal head. This trunk contains fibres from lumbar roots L4 and L5 and connects the lumbar with the sacral plexus. The outcome was favourable in both patients. If subsequent pregnancies occur, caesarean section may be indicated.

Adult↗
PubMed2000

[Laser conization and laser ablation of the transformation zone].

OBJECTIVE: To evaluate postoperative courses and histological results after laser therapy of the transformation zone. METHOD: From 1993 to 1997, 136 laser interventions were performed (110 conizations and 26 vaporizations); 103 (76%) of these interventions were performed as outpatient procedures and 122 (89%) under local anesthesia. RESULTS: 94 (85%) of the 110 conizations showed tumor-free margins, whereas 12 (11%) had dysplastic changes in one or both margins. Follow-up of these 12 patients revealed 5 normal cytologic controls, 4 cases of hysterectomy without residual disease, 1 case of CIN III in the hysterectomy specimen, 1 case of CIN I in a radical hysterectomy (cervical cancer stage Ib in the histology of the conus), and 1 patient was lost to follow-up. In 4 cases (4%), there was only a suspicion of marginal involvement. These patients had either a normal cytologic control (n = 3) or no residual disease in the hysterectomy specimens (n = 1). There were eight bleedings that had to be treated with bicoagulation. CONCLUSIONS: Laser therapy offers the possibility of a very precise circumcision at the ectocervical site under colposcopic control. It can mostly be performed as an outpatient procedure under local anesthesia, and the frequency of postoperative complications compares to the other available methods. If the margins show dysplastic changes, follow-up rarely reveals recurrent disease. Expectative management with close cytologic follow-up is, therefore, justified in such cases, if fertility should be maintained.

Adult↗
PubMed2000

[Postpartum footdrop due to compression of the lumbosacral trunk].

We report on a rare peripartal neuropathy of the leg caused by pro longed difficult labor in which forceps were used or caesarean sec tion was performed. Immediately after delivery, the 2 patients corn plained of a unilateral footdrop and numbness in the leg. The foot drop was most likely due to a compression of the lumbosacral trunl exposed to the fetal head. This trunk contains fibres from the lumba roots L4 and L5 and connects the lumbar with the sacral plexus. The outcome was favourable in both patients. If subsequent pregnancies occur, caesarean section may be indicated.

Adult↗
PubMed1999

Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions.

OBJECTIVE: To examine the risks of vaginal delivery after previous cesarean and to find criteria to help decide whether a trial of labor or an elective repeat cesarean should be preferred. METHODS: We evaluated 29,046 deliveries after previous cesarean registered in a pooled database of 457,825 deliveries used to assess quality control in gynecology and obstetrics departments in Switzerland. RESULTS: Among the 17,613 trial-of-labor cases logged (attempt rate 60.64%), the success rate was 73.73% (65.56% after inducing labor and 75.06% after the spontaneous onset of labor). The following complications were significantly more frequent in the previous-cesarean group: maternal febrile episodes (relative risk [RR] 2.77; 95% confidence interval [CI] 2.52, 3.05), thromboembolic events (RR 2.81; CI 2.23, 3.55), bleeding due to placenta previa during pregnancy (RR 2.06; CI 1.70, 2.49), uterine rupture (92 cases; RR 42.18; CI 31.09, 57.24), and perinatal mortality (118 cases, including six associated with uterine rupture; RR 1.33; CI 1.10, 1.62). The postcesarean group also showed a 0.28% rate of peripartum hysterectomy (81 cases; RR 6.07; CI 4.71, 7.83). There was one maternal death in the group, compared with 14 maternal deaths in the group without previous cesarean (no statistical significance). The risk of uterine rupture for patients with previous cesareans was elevated in the trial-of-labor group compared with the group without trial of labor (RR 2.07; CI 1.29, 3.30), but all other maternal risks, including peripartum hysterectomy (RR 0.36; CI 0.23, 0.56), were lower. When comparing the women having a trial of labor, the 70 with uterine rupture more often had induced labor (24.29% compared with 13.92% in the nonrupture group; P = .013), had epidural anesthesia (24.29% compared with 8.44%; P < .001), had an abnormal fetal heart rate tracing (32.86% compared with 8.53%; P < .001), and had failure to progress (21.43% compared with 7.98%; P = .001). CONCLUSION: A history of cesarean delivery significantly elevates the risks for mother and child in future deliveries. Nonetheless, a trial of labor after previous cesarean is safe. Induction of labor, epidural anesthesia, failure to progress, and abnormal fetal heart rate pattern are all associated with failure of a trial of labor and uterine rupture.

Adult↗
PubMed1999

[Systematic scientific quality improvement in surgical specialties. The AQS mode].

BACKGROUND: How can the new legal requirements (Law on Statistics 1992 with its corresponding regulations of 1993: minimum data record of the Federal Department of Statistics (BFS) with ICD codification and the law on medical insurance 1995 with its corresponding regulations of 1996: necessity of documenting quality and efficiency) be integrated into the daily hospital routine with reasonable expenditure of time and costs? METHOD: The BFS minimum data record was combined with additional information on quality improvement on one single questionnaire. The surgical departments of the Hospital Limmattal in Schlieren and the Regional Hospital Bienne founded the Association for Quality Improvement in Surgery (AQC) in 1995 and have tested the AQC system for two years. RESULTS: Until the end of 1997 data from 15,115 surgical procedures were collected in our database. In addition to the more time consuming collection of the "minimal data set of the Federal Department of Statistics (BFS)" which requires between 3 to 10 minutes, the collection of the additional AQC-data will take 1 to 3 minutes. DISCUSSION: There is an increasing expenditure of time and costs as a result of legal requirements. Expenditure may, however, be kept within manageable limits if a single questionnaire serves several purposes simultaneously. The AQC system does not only meet the legal requirements as to systematic quality improvement and BFS statistics, but can also be used for the annual statistics of the clinic, the statistics of individual surgeons, and for hospital comparisons provided other clinics adopt the system as well. There are no standards, reference areas or indicators as yet, but such tools may now be developed much more easily with comprehensive data available through the AQC system. CONCLUSIONS: The AQC system has proved to be a manageable tool in the hospital routine; it could thus be implemented as a wide-area system to provide systematic quality improvement and to meet other statistical requirements.

Humans↗
PubMed1998

[Statistical models with reference to their value for medical process quality assurance].

Since the revision of the KVG (Art. 58) (Health Insurance Law) in 1995, systematic scientific monitoring is laid down by statute in order to ensure quality (Health Insurance Regulations; KVV Art. 77). In addition, the statistics law of 1992 prescribes the BFS statistics (with ICD coding) (model 1). Since 1983 the "Arbeitsgemeinschaft Schweizerischer Frauenkliniken" (ASF) (The Swiss Working Group of Obstetrical and Gynecological Institutions) has been maintaining a common set of statistics which amongst other things also serves for quality assurance purposes (model 2). In 1995 a number of surgical hospitals joined together under the title "Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie" (AQC) (Swiss Surgical Quality Assurance Working Group) and now also maintain similar common statistics (model 3). In this paper the three above-mentioned models are described with regard to their suitability for process quality assurance. Whilst the BFS statistics are unsuitable for this purpose, the two other methods of data collection largely fulfil the requirements for process quality assurance by using statistical models. The largest deficiency in the ASF and AQC statistics is the lack of comprehensive geographical coverage which in contrast is provided by the BFS statistics thanks to statutory requirements. However, all three models are unsuitable for the areas of structure and outcome quality assurance. Therefore other solutions must be sought for these purposes.

Data Collection↗
PubMed1998

[Hormone substitution therapy after breast cancer--a reevaluation].

Up to recently women with a history of breast cancer were not allowed relief of menopausal symptoms with hormonal replacement therapy (HRT). The reasons for this attitude were the following: in vitro breast cancers are hormone-dependent tumours; the number of ovulatory cycles influences the risk of breast cancer; ovarectomy as an adjuvant measure after breast cancer is effective; anti-oestrogens are effective against breast cancer. Nowadays issues of quality of life have become more important and HRT has been reassessed in the light of the following considerations: there is no real alternative to HRT for severe menopausal symptoms; subsequent pregnancies (with concomitant high oestrogen levels) do not appear to worsen the prognosis of breast cancer; oestrogen therapy of metastatic breast cancer was described as a successful therapy in earlier times; up to now it has not been proved that HRT for a short period of time influences the risk of developing breast cancer; thus far several smaller studies of HRT after breast cancer have not demonstrated any worsening breast cancer prognosis; certain anti-oestrogens are very effective against breast cancer even though they also have a relevant tissue-specific oestrogenic activity. Furthermore, all the other positive effects of HRT (prevention of osteoporosis and lowering of the risk of myocardial infarction) are arguments for more liberal but controlled prescription of oestrogens. Until more is known about HRT after breast cancer we suggest treatment of menopausal symptoms in women with a history of breast cancer be given only within the HABITS study (HABITS: Hormonal replacement therapy after breast cancer diagnosis--is it safe?). This study has the support of the International Breast Cancer Study Group (IBCSG).

Breast Neoplasms↗
PubMed1997

Premature contractions: possible influence of sonographic measurement of cervical length on clinical management.

In a retrospective case control study with historical controls, the influence of the introduction of vaginal sonographic cervical length measurement on the utilization of hospital services and pregnancy outcome of gravid women at risk of preterm delivery was examined. Prior to the introduction of vaginal ultrasonography to measure cervical length, we registered 76 hospitalizations totalling 1827 hospitalization days due to premature cervical ripening and/or premature labor in 1991 and 1992. In 1994 and 1995, after vaginal ultrasonography was introduced and intravenous tocolysis was limited to cases with cervical shortening to less than 3 cm, there were 64 admissions resulting in just 869 hospitalization days. Long-term hospitalizations (over 10 days) were reduced from 55 to 25 cases (p < 0.0001) and the median length of hospital stay decreased from 18 to 8 days (p < 0.0001). The number of preterm births (< or = 37 weeks) remained stable: 12 cases in 1991-1992 and 13 cases in 1994-1995. In conclusion, vaginal sonographic measurement of cervical length provides an objective criterion for cervical shortening with premature labor. The method could therefore be a suitable means of reducing unnecessary therapeutic interventions in gravid women with premature contractions and/or cervical dilatation. A prospective randomized trial to confirm these findings is suggested.

Case-Control Studies↗
PubMed1996

Axillary lymphadenectomy--just how radical should it be?

UNLABELLED: To determine whether local axillary recurrences correlate with the number of lymph nodes extirpated, 779 cases of breast cancer were analysed in retrospect. RESULTS: The number of lymph nodes extirpated varied between 1 and 42 per axilla. The axillary recurrence rate of 5.5% showed a minimal correlation between the frequency of these recurrences and the number of lymph nodes removed. There is an equally insignificant correlation between the percentage of positive histological findings and the number of lymph nodes extirpated: The trend analysis shows that with fewer than five lymph nodes extirpated, 40% of positive histological findings can be expected, whereas with over 20 lymph nodes extirpated the percentage is 45%. CONCLUSION: The number of lymph nodes extirpated is an unsuitable indicator as to how radical axillary clearance is. Surgeons should rely on anatomical boundaries rather than focusing on the number of lymph nodes removed.

Adult↗
PubMed1992

[Prognostic and therapeutic significance of steroid receptors in invasive breast cancer].

It is generally accepted that breast cancer with positive steroid receptors has a better prognosis than with negative receptors. The aim of this study was to analyse the influence of the oestrogen (ER) and progesterone (PR) receptors regarding disease-free interval (DFI) and overall (oa) survival of 441 patients operated on in the Department of Gynaecology of the University Hospital of Zürich. Analysis of the subgroups separated according to menopausal status showed the following results: Premenopausal patients (n = 135): Only PR have a significant influence on the oa-survival (p = 0.0370), not the ER. The DFI was independent of ER and PR positive findings. Postmenopausal patients (n = 306): In this group only the ER has a significant influence (p = 0.0296) on the oa-survival, not the PR. Both steroid receptors did not have any influence regarding DFI. Metastases and local recurrence occur pre- and postmenopausaly approximately at the same time, independent of the quality of the steroid receptors. The better oa-survival despite the same DFI can be explained by a better response to the therapy by patients in the premenopause with positive PR status and patients in the postmenopause with positive ER status.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Long-term results of varicocelectomy.

Between 1983 and 1985, 257 infertile men were examined for any present varicocele by means of the Doppler sonography, telethermography and palpation. Based on these findings, the spermiogram and the infertility history, high ligation of the spermatic vein was indicated in 89 patients with varicocele and a median duration of infertility of 36 months (6-88 months). Postoperative sperm examinations have shown a significant improvement in sperm count and morphology, but not in motility. The most significant drop was observed in germ cell concentration from 1.68 to 1.06 mio/ml (p less than 0.025 Wilcoxon signed rank sum test). The follow-up examination 6 years after the beginning of the study has shown that only 56 out of the 89 patients underwent surgery, whereas 33 patients refrained from it. Pregnancy rates were 42% (23 out of 55, 1 patient lost to follow-up) in the operated group and 45% (14 out of 31, 2 patients lost to follow-up) in the nonoperated group. The comparison of the two graphs showing pregnancy incidence clearly demonstrates that pregnancies in the nonoperated group occur earlier than in the operated group; it has to be noted, however, that several patients only refrained from being operated on because pregnancy had occurred before surgery was planned. On the one hand, our study confirms other authors' results, i.e. that pregnancy rates in the nonoperated group are relatively high despite present varicocele. On the other hand, the operated group achieved practically the same high pregnancy rate when monitored over a longer period of time.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1991

[Prognosis of local-regional recurrence in breast carcinoma].

992 primary breast cancers were treated at the Gynaecological Department of the University Hospital of Zürich between 1971 and 1988. Local recurrence (LR) has occurred in 131 patients up to now after a median follow-up of 5.1 years. 75% of the LR manifested the first three years after operation. Especially the locoregional (axillary) recurrences occurred early. The frequency of LR was independent of the menopausal status and the steroid receptors, but was dependent on the initial axillary nodal status and the tumor size. Patients with nodal involvement had recurrences significantly more often (74 of 372 = 20%) than those without (34 of 469 = 7%). LR of patients with tumors smaller than or equal to 2 cm occurred in 7%, in patients with tumors greater than 2 cm in 17%. The 5-year survival of all patients and the patients with a LR was 80% and 57% respectively. The longer the disease-free interval, the better the prognosis of survival. The findings suggest, that especially an early LR can not be looked at as merely a local problem but rather as a signal of a systemic manifestation of the disease.

Breast Neoplasms↗
PubMed1991

[Risk factors in breast carcinoma].

A group of 992 breast cancer patients (risk group, R) was compared with a group of 482 patients hospitalized for non oncologic reasons and matched for age and year of hospitalization (comparison group, C). The findings confirm the following factors as risk factors for breast cancer: nulliparity (R 28.8%, C 17.5%, p less than 0.001), late first birth (over 34 years of age) (R 11.4%, C 5.1%, p less than 0.001), diabetes mellitus (R 7.0%, C 3.8%, p = 0.017), hypertension (R 25.7%, C 18.1%, p = 0.0016), alcohol (R 9.4%, C 5.9%, p = 0.03), positive family history (R 14.8%, V 5.3%, p less than 0.001) and breast surgery for benign disease (R 13%, C 7.5%, p = 0.002). Frequently mentioned risk factors such as early menarche and late menopause did not emerge as risk factors in our study. Cigarette smoking did not show a protective effect but even tended to be more frequent in the risk group. Multiparity (more than 2 births) was protective (R 22.1%, C 32.4%, p less than 0.001). The findings on hormonal replacement therapy (R 7.1%, V 17.0%, p less than 0.01) might have been influenced by a selection bias (hospitalization of patients in the comparison group because of complications of hormonal replacement therapy such as bleeding) and are thus not fully conclusive. It can at least be said that hormonal replacement therapy is not more frequent in the risk group.

Adult↗
PubMed1991

Timing of breast cancer surgery within the menstrual cycle: influence on lymph-node involvement, receptor status, postoperative metastatic spread and local recurrence.

Prompted by a report of Hrushesky et al. stating that women operated upon for breast cancer during their perimenstrual period showed a higher risk for developing future metastases than women operated upon during their mid-cycle, we examined the patients with breast carcinoma who were treated at the Gynaecological University Hospital Zürich between 1971 and 1988 with respect to the influence of menstrual cycle phase on certain factors. 104 patients underwent perimenstrual surgery, i.e., between days 1 and 6 or days 21 and 36 of the cycle. 120 women had mid-cycle surgery (i.e., days 7-20 of the cycle). In contrast to the experience of Hrushesky et al., we found no significant differences in the survival curves. The same was true when the proliferative phase (days 1-14; n = 109) was compared with the secretory phase (days 15-32; n = 108). We tested the different groups for homogeneity and found that 54% of the patients with perimenstrual surgery showed axillary lymph node involvement, whereas in the midcyclic group only 38% showed positive nodes. We have no plausible explanation for this difference. These findings indicate that there might be certain cycle-related differences with respect to lymph node status but that they do not affect survival. Hence, timing surgery to the menstrual cycle is not mandatory for the time being.

Breast Neoplasms↗