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Biomedical subjects

R Steffen

Publications and source records attributed to R Steffen.

At least 19 recordsLinked to original sources
PubMed1996

[Routine immunization of infants in the Canton of Zurich].

At present there is a shortage of data regarding the rate of routine immunization in Swiss children. To address this deficit, a representative cross sectional study was conducted in the Canton of Zurich with 210 children aged between 24 and 36 months. Data was taken from the individual official vaccination certificates. 178 vaccination certificates (55.1% female and 44.9% male) were evaluated, corresponding to a response rate of 84.8%. With children of foreign nationalities, the response rate was 66.7%, whereas the response rate of Swiss children was 90.6% (p < 0.001). The response rate of children of a European nationality outside the European Union was especially poor (33.3%). The immunization rate with three doses of diphtheria, tetanus and poliomyelitis vaccines was 99.4%, and that of the pertussis vaccine was 93.3%. With the vaccines for measles, mumps and rubella the rates were 80.3%, 78.1% and 77.5% respectively. Vaccination rate against Haemophilus influenzae type B was 74.7% with two doses, and 61.2% with three doses. The timing and the number of doses of the vaccines used for infants in the Canton of Zurich were satisfactory. However, the vaccination rate for measles, mumps and rubella is inadequate. Attention should be paid to this problem and also to possible insufficient care of foreign children.

Child, Preschool↗
PubMed1995

Hepatitis A in travelers: the European experience.

Each year approximately 14 million Europeans travel to developing countries in Africa, Asia, and Latin American as well as to infrequently visited countries in eastern Europe. Without protection, travelers develop symptomatic hepatitis A at the rate of 3 cases per 1000 people per month of stay. Those who eat and drink under poor hygienic conditions have an even higher risk, 20/1000/month. Studies show that hepatitis A is the most frequent vaccine-preventable disease in travelers to developing countries. Immunity to hepatitis A virus is infrequent among northern European travelers, except for those born before 1945, with a history of jaundice, or who lived for > 1 year in a developing country.

Europe↗
PubMed1995

Benefit/risk considerations with respect to OTC-descheduling of loperamide.

The main criteria to be considered for releasing an antidiarrhoeal from a prescription to an OTC-drug are guaranteed quality control, established efficacy and safety and the evaluation of the drug experience on major markets. Besides the considerable benefits from a socio-economic point of view, the risk for potential inappropriate use of loperamide (CAS 53179-11-6) as self-medication can be minimized by its use being avoided in children of 5 years of age or less (e.g. by making available a solid formulation only), by limiting the treatment duration to 48 h, and by contraindicating the use of the drug in cases of fever (> 38 degrees C) and/or blood in the stools. On the basis of a broad review loperamide can be considered to be efficacious in acute non-specific, acute functional and traveller's diarrhoea. The agent has a good safety profile if the mentioned restrictions are born in mind. Loperamide thus satisfies the OTC criteria.

Adult↗
PubMed1995

Behavioural aspects of travellers in their use of malaria presumptive treatment.

The use of stand-by treatment for malaria by travellers depends on their knowledge, attitudes and behaviour. We examined the behavioural aspects of a cohort of travellers from Switzerland to low-risk malarial areas who, on recruitment, were provided with a kit containing medication for stand-by treatment, guidelines on the diagnosis of malaria, and materials for collection of blood samples for later confirmation of malaria. All subjects were urged to seek medical advice at the first signs of possible malarial symptoms. Illness (fever as the main indicator) was reported by 123 of the 1187 participants, often accompanied by shivering/chills (36.6%), headache (35.0%), gastrointestinal symptoms (69.9%), and myalgia and/or arthralgia (41.5%). Two-thirds of those ill failed to seek medical attention despite their symptoms and pretravel advice. Only 9 (7.3%) were actually beyond the reach of medical attention. The stand-by treatment was self-administered by 6 travellers, only one of whom had confirmed malaria. Two non-serious adverse events were reported. All users consulted a physician after administering the presumptive treatment. This stand-by approach is limited by inappropriate behaviour and poor malaria awareness among travellers. These negative factors can be mitigated by development of an improved kit containing a simple test for self-diagnosis.

Adult↗
PubMed1995

Efficacy and tolerance of insoluble carob fraction in the treatment of travellers' diarrhoea.

The water-insoluble carob fraction (fraction insoluble caroube, FIC, Nestlé) has been successfully used in the treatment of infantile diarrhoea. To investigate the efficacy and toxicity of FIC (1970 mg to be taken every 2 hours over a 48-hour period except during sleeping time) in the treatment of travellers' diarrhoea in adults, a double-blind, computer randomized, placebo-controlled study was conducted. Of the 755 volunteers recruited at the Zurich University Vaccination Centre, 628 (83.5%) returned their questionnaires. Among them, 164 (27.7%) had diarrhoea, but only 69 (42%) used the trial medication correctly; the others were rated non-complaint. No significant difference in efficacy (p = 0.12) or adverse effects were observed in the two study groups. In conclusion, FIC, although showed a positive trend, was not efficacious.

Adolescent↗
PubMed1995

Treatment of travellers' diarrhoea: zaldaride compared with loperamide and placebo.

OBJECTIVE: To compare zaldaride maleate, a calmodulin inhibitor with gastrointestinal antisecretory properties, with loperamide and a placebo in the treatment of travellers' diarrhoea. DESIGN: Randomized, double-blind, double-dummy study. SETTING: Study clinic staffed by European residents on Nile cruise ships. PATIENTS: Tourists (n = 436) who acquired travellers' diarrhoea during the Nile cruise. INTERVENTIONS: (1) Zaldaride 20 mg four times daily, (2) zaldaride 2 x 20 mg as initial loading dose followed by three doses of 20 mg on the first day and four doses of 20 mg on the second day, (3) loperamide 2 x 2 mg loading dose following by a flexible dosage of 2 mg after each unformed stool (maximum of 16 mg daily), (4) placebo. MAIN OUTCOME MEASURES: Number of unformed stools, rate of improvement of patients with diarrhoea, rate of relief from diarrhoea. RESULTS: Among the 331 compliant and fully evaluated patients, the zaldaride with loading dose group showed no significant differences in cure rates from the loperamide group. For most parameters, zaldaride without a loading dose and the placebo resulted in significantly lower cure rates. CONCLUSIONS: A zaldaride regimen including a loading dose was shown to be well tolerated and as effective as loperamide.

Adolescent↗
PubMed1994

Epidemiology and prevention of hepatitis A in travelers.

OBJECTIVE: To assess the risk of hepatitis A in international travelers and to recommend preventive measures. DATA SOURCES: Index Medicus, 1974 through 1983; MEDLINE, 1984 through 1993; and unpublished data of the Centers for Disease Control and Prevention. STUDY SELECTION: Review of all retrospective and cohort studies on hepatitis A and other vaccine-preventable diseases in travelers, of seroepidemiologic surveys of hepatitis A virus (HAV) antibodies in travelers, of data on the various hepatitis A vaccines, of economic analyses, and of recommendations of recognized organizations. DATA EXTRACTION: Independent analysis by multiple observers. DATA SYNTHESIS: The incidence rate for unprotected travelers, including those staying in luxury hotels, is estimated to be three per 1000 travelers per month of stay in a developing country. Persons eating and drinking under poor hygienic conditions have a rate of 20/1000 per month. This makes hepatitis A the most frequent infection in travelers that may be prevented by immunization. In many industrialized countries persons born after 1945 have an HAV antibody seroprevalence (immunity) of less than 20%. New inactivated HAV vaccines induce protective antibodies in more than 95% of recipients and offer protection estimated to last for 10 years or more, whereas protection by immune globulin lasts only 3 to 5 months. CONCLUSIONS: Hepatitis A vaccine, or immune globulin where HAV vaccine is not available, is recommended for all nonimmune travelers visiting developing countries. Prescreening for antibodies to HAV in travelers living in countries with low prevalence is usually not necessary in persons born after 1945.

Cost-Benefit Analysis↗
PubMed1994

[Do's and don'ts in travel medicine advice].

The cornerstones of a travel health consultation are: information, advice on anti-mosquito measures, vaccinations, malaria chemoprophylaxis and guidelines for presumptive treatment. The art of travel medicine is the ability to focus on the realistic health needs of the traveller whilst leaving aside superfluous information. In this way, unnecessary adverse events, expenses and patient anxiety can be avoided.

Antimalarials↗
PubMed1994

Advances in hepatitis A prevention in travellers.

The introduction of an active vaccine against hepatitis A, the most frequent of the vaccine-preventable infections in travellers, is an important contribution to travellers' health. Although theoretically the risk of exposure may be minimised by taking hygienic precautions, most travellers in practice remain at considerable risk. As compared to immunoglobulin, vaccine has the advantages of better and long-lasting protection. A double-strength vaccine has been introduced (HAVRIX, 1440 enzyme-linked immunosorbent [ELISA] units [EL.U]) and a single injection will protect from day 14 for 1 year. No significant adverse events have been reported. Questions that remain unanswered are whether travellers leaving before day 14 should receive immune globulin plus vaccine and whether very young travellers should all be immunised.

Hepatitis A↗
PubMed1994

Bacterial and fungal colonization and infections using oral selective bowel decontamination in orthotopic liver transplantations.

Bacterial and fungal infections are a major cause of morbidity and mortality after orthotopic liver transplantation. In the immunocompromised host, infections are thought to arise from the gut, which is almost always colonized with potential pathogens. Using oral selective bowel decontamination (SBD), potential pathogens can be eradicated from the gut and infections prevented. In this catamnestic study we have reviewed gastrointestinal colonization, bacterial and fungal infections, and bacterial resistance to standard antibiotics in our first 206 liver transplant patients while under SBD. With few exceptions, gram-negatives were eradicated from the gastrointestinal tract and secondary colonization was inhibited. In spite of unsatisfactory elimination of Candida, probably because nystatin doses were too low, Candida infections were rare (n = 4) and none was fatal. One and two-year survival rates were 93% and 92%, respectively. The bacterial and fungal infection rate was 27.8% with an infection-related mortality of 1.95%. Infections with aerobic gram-positive bacteria prevailed and only 11 gram-negative and 11 fungal infections occurred; among the latter, Aspergillus and Mucor were the most serious and responsible for three of the six deaths in this series. With regard to the development of resistance, we found an increasing number of enterococci and coagulase-negative staphylococci resistant to ciprofloxacin and imipenem, respectively, but unlikely as a consequence of SBD.

Administration, Oral↗
PubMed1994

Experience with cuff rearterialization in 600 orthotopic liver grafts in the rat.

The model of orthotopic rat liver transplantation has been a useful tool in transplantation research for two decades. Due to technical problems, the optional hepatic artery anastomosis is not performed in many experiments. Recently developed techniques, however, have made rearterialization a simple procedure. With our technique of cuff rearterialization to the recipient common hepatic artery, in 600 rat liver grafts we achieved high viability, and an early patency rate of 100%. Patency rates after 2 and 21 days were nearly 90%. Cuff rearterialization is simple, rapid to perform, and provides a physiologic model. Compared to strictly venous liver grafts, rearterialized grafts demonstrate improvement in survival, more rapid normalization of liver function parameters, a better preserved liver structure, and less biliary complications. Rearterialization is an important component of a physiologically relevant rat liver transplantation model, and non-specific changes due to arterial ischemia may adversely affect the interpretation of experimental data.

Anastomosis, Surgical↗
PubMed1994

Technique and results of biliary reconstruction using side-to-side choledochocholedochostomy in 300 orthotopic liver transplants.

OBJECTIVE: The authors evaluated the complication rate and outcome of side-to-side common bile duct anastomosis after human orthotopic liver transplantation. SUMMARY BACKGROUND DATA: Early and late biliary tract complications after orthotopic liver transplantation remain a serious problem, leading to increased morbidity and mortality. Commonly performed techniques are the end-to-end choledochocholedochostomy and the choledochojejunostomy. Both techniques are known to coincide with a high incidence of leakage and stenosis of the bile duct anastomosis. The side-to-side bile duct anastomosis has been shown experimentally to be superior to the end-to-end anastomosis. The authors present the results of 316 human liver transplants, in which a side-to-side choledochocholedochostomy was performed. METHODS: Biliary tract complications of 370 transplants in 340 patients were evaluated. Three hundred patients received primary liver transplants with side-to-side anastomosis of donor and recipient common bile duct. Thirty-two patients with biliary tract pathology received a bilioenteric anastomosis, and in eight patients, side-to-side anastomosis was not performed for various reasons. Clinical and laboratory investigations were carried out at prospectively fixed time points. X-ray cholangiography was performed routinely in all patients on postoperative days (PODs) 5 and 42. In patients with suspected papillary stenosis, endoscopic retrograde cholangioscopy and papillotomy were performed. RESULTS: One biliary leakage (0.3%) was observed within the early postoperative period (PODs 0 through 30) after liver transplantation. No stenosis of the common bile duct anastomosis was observed during this time. Late biliary stenosis occurred in two patients (0.6%). T tube-related complications were observed in 4 of 300 primary transplants (1.3%). Complications unrelated to the surgical technique, including papillary stenosis (5.7%) and ischemic-type biliary lesion (3.0%), which must be considered more serious in nature than complications of the anastomosis or T tube-related complications, were observed. Papillary stenosis led to frequent endoscopic interventions and retransplantations in 1.3%. CONCLUSIONS: Side-to-side common bile duct anastomosis represents a safe technique of bile duct reconstruction and leads to a low technical complication rate after human orthotopic liver transplantation. Ischemic-type biliary lesion evoked by preservation injury, arterial ischemia, cholestasis, and cholangitis may represent a new entity of biliary complication, which markedly increases the morbidity after human liver transplantation. Therefore, this complication should be the subject of further research.

Adolescent↗
PubMed1994

The results of strictureplasty in pediatric patients with multifocal Crohn's disease.

This study is a retrospective review of eight pediatric patients with multifocal intestinal Crohn's disease who underwent strictureplasty with or without concomitant bowel resection between January 1978 and April 1992. The patients ranged in age from 9.9 years to 18.5 years. Indications for surgery were partial intestinal obstruction (n = 6), failure of medial therapy or steroid dependence (n = 4), growth failure (n = 2), and enterocutaneous fistula (n = 2). Thirty-six strictureplasties were performed in the eight patients (median, 4.5 strictureplasties per patient; range, 1-12). Bowel resection was performed in six of the eight patients in areas where strictureplasty was not feasible. The mean length of resection was 40 cm (range, 15-82 cm). The only complication was intestinal hemorrhage, which was conservatively managed in two patients. The patients were followed for a mean of 19 months (range, 3-55 months). Five patients had a weight below the fifth percentile prior to surgery. Postoperatively, there was a weight gain in seven patients, including all five patients who were originally below the fifth percentile. A statistically significant weight gain was found when a paired t test analysis was applied to the entire group (p = 0.04). Five of six patients who were on steroid medication at the time of surgery were successfully weaned within 1.5-3 months (mean, 2.3 months) from the time of surgery. Seven of eight patients had relief of their intestinal symptoms. Strictureplasty with small-bowel resection, or perhaps strictureplasty alone, in pediatric patients with multifocal intestinal Crohn's disease can improve gastrointestinal symptoms, promote weight gain, and allow discontinuation of steroid medications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗