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D Heim

Publications and source records attributed to D Heim.

At least 19 recordsLinked to original sources
PubMed2004

High-dose chemotherapy using BEAM for tumor debulking without stem cell support followed by early allogeneic reduced intensity conditioning transplantation to induce a graft-versus-lymphoma effect in patients with high risk or refractory lymphoma.

In patients with refractory lymphoma, we tested the hypothesis that high-dose chemotherapy (BEAM) without stem cell support followed by a reduced intensity (RIC) allogeneic transplant with fludarabine and 2 Gy TBI 28 days later results in tumor debulking and establishment of a graft vs lymphoma effect, with acceptable toxicity. In a pilot protocol we treated 10 patients, 22-62 (median 47) years of age with high-risk or refractory Hodgkin's or non-Hodgkin's lymphoma. Donors were HLA identical siblings (eight) or unrelated volunteers. None died during the neutropenic phase after BEAM which lasted up to the RIC HSCT. The duration of neutropenia was 31-43 (median 36) days. All patients engrafted and nine achieved CR. All developed acute GvHD (median grade III) and all patients at risk developed chronic GvHD. Three patients died of GvHD. One relapsed and six patients are in continuous CR 10-32 (median 15) months after HSCT. This approach appears feasible and results in a high response rate. Neutropenia duration is of concern. It remains to be tested whether separation of debulking chemotherapy and induction of allogeneic effects confers an advantage.

Adolescent↗
PubMed2003

[The value of ultrasound diagnosis in "acute appendicitis" patient admission].

UNLABELLED: The rate of unnecessary appendectomy is frequently criticized. Today, sonography and CT-scan are helpful tools to minimize this rate. Which value has the ultrasonography in the decision making today? METHODS: Retrospective analysis of 132 patients undergoing appendectomy in respect of sonography and rate of histologically confirmed appendicitis from 1.1.95-31.12.98. Prospective analysis of 99 patients admitted for acute appendicitis in respect of pre- and posttest-probability (after sonography) by the responsible surgeon from 1.1.99-31.12.00. RESULTS: Retrospective part: 122/132 patients had an acute appendicitis (92%). Sonography was performed in 64% of the patients. There was only one wrongly positive sonography. Prospective part: 76/99 patients were operated on. 70/76 had an acute appendicitis (92%). Sonography was performed in 87%. Six patients presented a histologically normal appendix: In two of them no increase of the probability after sonography was noted, in three of them an slight increase of only 20%, and in one of them a decrease of 20% even. CONCLUSION: Sonography with a pre- and posttest-probability is recommended in clinically doubtful cases. In our experience the physician performing the sonography is almost always right. But the diagnosis of an acute appendicitis remains a combination of clinical and sonographic evaluation.

Acute Disease↗
PubMed2003

Risk management of transmissible spongiform encephalopathies in Europe.

Bovine spongiform encephalopathy (BSE) was first described in the United Kingdom (UK) in November 1986. After the introduction of an active surveillance system, most countries in Europe have reported BSE cases in the cattle population. This indicates that the use of active surveillance in addition to passive surveillance is important to assess the true BSE status in a country. Scrapie, a transmissible spongiform encephalopathy (TSE) in sheep and goats, has been reported in countries throughout the world with a few notable exceptions. Concern was expressed that BSE could have been introduced into sheep and goats. Currently, distinguishing between scrapie and BSE in small ruminants is only possible through lengthy experiments in mice. Preliminary results of active surveillance, introduced in 2002, show that significant under-reporting occurred. The history of BSE in cattle shows that risk assessments concerning the risk in a given country were often ignored and subsequent risk management decisions were inaccurate, i.e. although the risk was probable, no measures were taken in terms of either animal or human health. Furthermore, the effect of the measures taken was often overestimated and these had to be amended several times. The most important action to prevent new cases of TSEs occurring is by banning the feeding meat-and-bone meal (MBM) to ruminants. Further measures to be considered are the exclusion of specified risk material and carcasses from rendering, the process parameters for rendering of animal waste and the prevention of cross-contamination of feed with MBM. The most important measures to protect the consumer are the ban on specified risk material, such as brain and spinal cord, which may contain particularly high concentrations of the BSE agent, and the ban on mechanically recovered meat. The most important measures taken in Europe and the scientific background thereof are described and discussed.

Animal Feed↗
PubMed2002

Geographical clustering of cases of bovine spongiform encephalopathy (BSE) born in Switzerland after the feed ban.

Over one-third of the cases of BSE in Switzerland have been born after the feed ban of December 1, 1990. Evidence for the geographical clustering of these cases emerged in two distinct regions. All the 354 BSE cases recorded until June 30, 2000 (set A), and the 376 cases recorded up to May 14, 2001 (set B), were georeferenced to the centres of the communities in which the herds of origin were located, and control populations were georeferenced to the centres of the communities in which these herds were located at the time of the census. The latitudes and longitudes of these centres were used in the statistical analysis of the spatial clustering. The Cuzick-Edwards test and the spatial scan statistics were applied to assess the significance of the clusters, while controlling for the spatial distribution of the underlying cattle population. There was global clustering of the cases born after the ban, and distinct and significant (P<0.05) spatial clusters were repeatedly identified in the two case datasets, and in several control populations (all cases born before the feed ban on a random sample of control farms) in terms of cattle density by region or cow density by region. Differential reporting was excluded as the underlying reason for the observed clusters.

Animals↗
PubMed2002

Do type B malleolar fractures need a positioning screw?

UNLABELLED: Type B malleolar fractures (AO/ASIF classification) are usually stable ankle joint fractures. Nonetheless, some show a residual instability after internal fixation requiring further stabilization. How often does such a situation occur and can these unstable fractures be recognized beforehand?From 1995 to 1997, 111 malleolar fractures (three type A, 90 type B, 18 type C) were operated on. Seventeen out of 90 patients (19%) with a type B fracture showed residual instability after internal fixation (one unilateral, four bimalleolar and 12 trimalleolar fractures). Five of these patients showed a dislocation in the sagittal plane (anteroposterior) clinically or on the radiographs, five a dislocation in the coronal plane with dislocation of the tibia on the medial aspect of the ankle joint, and four an incongruency on the medial aspect of the joint. In three cases, no preoperative abnormality indicating instability was found. The fractures were all fixed using an additional positioning screw. In 11 patients, the positioning screw was removed after 8-12 weeks, in six patients removal was performed after 1 year along with removal of the plate. All 17 patients were reviewed 1 year after internal fixation, 16/17 showed a good or excellent result with identical or only minor impairment of range of motion of the ankle joint. CONCLUSION: Unstable ankle joints after internal fixation of type B malleolar fractures exist. Residual instability most often occurs after trimalleolar fractures with initial joint dislocation. Treatment with an additional positioning screw generally produced a satisfactory result.

Adult↗
PubMed2002

[A method to identify BSE suspects in emergency slaughtered cattle during ante mortem examination].

A method is presented by which a maximal number of BSE-infected cattle that had escaped the filter of clinical examination are identified during ante mortem examination. This approach might prove to be an efficient and cost-effective method for veterinary and non-veterinary meat inspectors to remove infected animals prior to slaughter. In a case-control study, the clinical signs of 224 randomly selected sick slaughtered animals were compared with the clinical signs of 26 sick slaughtered animals in which BSE infection was diagnosed using a rapid test post mortem. In addition, the clinical signs of the sick slaughtered BSE-positive animals were compared with the clinical signs of a group of BSE suspects identified during the same time period and in which BSE infection could be confirmed. As a result of this study a mathematical model was developed to identify BSE suspects. This model contains a total of 7 variables (clinical signs) that proved to be of importance. These signs were aggressive behaviour, grinding of teeth, protruding eyeballs, reduced rumination, inability to stand, overexcitability, and difficulty in standing up. The presented model has a sensitivity of 61.5% (16 out of 26 BSE-positive animals slaughtered while sick were identified) and a specificity of 99.6% when compared to a rapid test conducted post mortem.

Animals↗
PubMed2002

[Beyond BSE: Transmissible spongiform encephalopathies in other animal species].

There are several other diseases besides BSE which belong to the group of transmissible spongiform encephalopathies (TSE). Although most mammals can be experimentally infected with the agent of these diseases, generally only single representatives of the orders Artiodactyla (cloven-hoofed animals), Carnivora (carnivores) and Primates (humans and monkeys) are naturally infected in the field. An overview of the current state of knowledge on TSE in several species like exotic ruminants, deer, mink and cats is presented. Etiological, clinical, anatomic-pathological and epidemiological aspects are described.

Animals↗
PubMed2002

[Transmissible spongiform encephalopathies in sheep and goats].

Scrapie has been known to occur in sheep and goats for over 250 years. Sheep and goats can be experimentally infected orally with BSE, however BSE infection can only be distinguished from scrapie using costly and extensive laboratory procedures. An overview of both the current state of knowledge on Transmissible Spongiform Encephalopathies (TSE) in small ruminants as well as the TSE monitoring and control strategies in place in Switzerland is presented.

Animals↗
PubMed2002

[Geographic distribution of BSE in Switzerland].

Visual evaluation of the occurrence of BAB (born after ban) cases pointed towards spatial clustering. Therefore a statistical analysis of spatial case clustering was conducted using GIS technology. In the initial analysis, all 376 cases (135 BAB, 241 BBB/born before ban) diagnosed through mid of March 2001 were investigated using the spatial scan statistic. Two clusters of BBB cases were identified in the western part of Switzerland, and two clusters of BAB cases in the eastern part. Epidemiological investigations performed within the BAB clusters showed an increased pig density in these cluster regions. Pig density is considered an indicator for the probability of contamination of cattle feed with feed containing meat-and-bone meal that is intended for other species (cross-contamination). In an updated cluster analysis including all cases reported until end of June 2002 (data set B), clusters were identified in the same regions as previously. It was shown that the BAB clusters occurred in different time periods. The small scale differences in cluster size and location are discussed, with an emphasis on the implications for following epidemiological investigations.

Animal Feed↗
PubMed2002

[Risk assessment as an indicator for the distribution of BSE in the world].

For a long time, BSE was considered a problem of the UK exclusively. Even after the detection of BSE cases in countries outside the UK, the risk of having BSE was categorically denied by many other countries. Only after the introduction of active surveillance did several "BSE free" countries detect BSE in their country. However, before the detection of the first cases in several of these countries, a risk assessment (GBR) conducted by the Scientific Steering Committee of the EU showed that a risk could be present. There remain many countries with an unknown BSE risk. In order to minimise import risks from these countries, further risk assessment is needed to evaluate the real BSE distribution worldwide.

Animals↗
PubMed2002

[Twelve years experience in Switzerland: Quo vadis BSE?].

When the first BSE case in Switzerland became public in 1990, it precipitated a chain of events with many diverse consequences. During this time, we continued to gain knowledge, implement new measures, and make practical recommendations in order to attempt to control the disease. This was made possible by the establishment of a huge data base containing information on all cases of BSE that had been diagnosed in Switzerland, as well as by the use of information from experiences in other countries. Analysis of these data allowed the sequence of events to be described temporally and spatially and an epidemiological evaluation to be made. These data also allow predictions to be made regarding the future of BSE in Switzerland, although these predictions must be interpreted cautiously.

Animals↗
PubMed2002

[Carpal tunnel syndrome after trauma].

UNLABELLED: The carpal tunnel syndrome is a frequent illness with several etiological factors. Its appearance after trauma is rare. In a retrospective study its incidence and the trauma pattern were analyzed. From 1.1.95 to 31.12.99 144 median nerve decompression procedures for carpal tunnel syndrome were performed in 114 patients. Twelve patients (10.5%) had suffered a trauma in the recent or more distant past. There were six distal radius fractures, three metacarpal fractures, one finger fracture, one humeral shaft fracture and one distal avulsion of the biceps tendon. In eight patients the symptoms appeared 1-3 months after trauma, in four patients there was an interval of several years. In all twelve patients electroneurography revealed pathological parameters on the symptomatic side, but in ten patients the contralateral side was also affected although there were no symptoms. According to the criteria given by Assmus and Frobenius [1], five patients showed an obvious and three patients a possible posttraumatic carpal tunnel syndrome. In four patients a distinct relation to the trauma could not be proven. CONCLUSION: The carpal tunnel syndrome after trauma is rare. Given the fact that the contralateral side in these patients was affected as well, a predisposition--due to a narrow carpal tunnel--is very likely. Its manifestation might be triggered by a pressure increase in the carpal tunnel as result of the trauma.

Adolescent↗
PubMed2002

[Interdisciplinary complications conference--also a (simple) kind of quality assurance].

Documentation of complications is a "must" today. Several societies have been formed and several systems of documentation exist to fulfill these requirements. But there are also very simple tools for quality management in every hospital. Since 1995 all surgical/orthopedic interventions have been prospectively recorded at the hospital of Frutigen. Every other month a list of all operations and their complications is put together by the two surgeons-in-chief. This list is then presented at the so-called interdisciplinary complications-conference. This meeting is open to all employees of the hospital and to all medical doctors of the region. From the 1st January 1995 to the 31st December 2001 7396 surgical interventions were performed on in- or outpatients. 134 complications (1.8%) occurred. These were: 49/7396 infections (0.7%), 14/1395 re-osteosyntheses (1%), 21/7396 hematomas requiring evacuation (0.3%), 8/7396 disturbances in wound healing (0.1%) and 42 other, postoperative complications. Postoperative infection occurred most frequently after appendectomies 10/251 (4%), the rate after internal fixation was 0.6% (9/1395). Hematomas were encountered most frequently after total joint replacement (hip and knee) 4/180 (2.2%), followed by inguinal hernias 4/287 (1.4%). The rate of re-osteosynthesis was highest after internal fixation of proximal humerus fractures 5/58 (8.6%). This systematic documentation of complications allows an analysis of the operative/perioperative management. By introducing specific measures (compression-bandage after operations of inguinal hernias and total hip prosthesis, new implant with rotational stability for proximal humerus fractures) an attempt can be made to reduce the rate of the most frequent complications. The public presentation of the complications at the meeting makes it possible to communicate good and bad results to the whole staff including the general practitioners, and the interdisciplinary mode of discussion permits the inclusion of not only the surgical but also all other possible aspects of the treatment of the patients.

Cross-Sectional Studies↗
PubMed2002

High stem cell dose will not compensate for T cell depletion in allogeneic non-myeloablative stem cell transplantation.

The best strategies for non-myeloablative stem cell transplants (NST) are not known. We hypothesized that a high stem cell dose and post-transplant donor lymphocyte infusions (DLI) in a T cell-depleted NST setting may result in stable engraftment without severe GvHD. We used conditioning with 200 mg/kg cyclophosphamide, and ATG, a high peripheral stem cell dose of >10 x 10(6) CD34(+) cells/kg, T cell-depleted to <1 x 10(5) CD3(+) cells/kg followed by incremental DLI. Ten patients, 53 (42-61) years of age with hematological malignancy (CML in 3, MDS in 2, myeloma in 3 and CLL in 2) were included. All patients achieved initial engraftment, at a median 13.5 (10-20) days. Three patients achieved complete chimerism, four achieved a complete hematologic remission. In seven patients the graft ultimately failed. Acute GvHD grade II was seen in three patients after DLI. At a median follow-up of 28 months (range 15-35), eight patients are alive, none died of treatment-related complications. NST with T cell depletion to prevent GVHD results in a high graft failure rate. High stem cell dose (> or =10 x 10(6) CD34(+)cells/kg) and post-transplant DLI will not compensate for the lack of T cells to ensure stable engraftment.

Adult↗
PubMed2001

Targeted screening of high-risk cattle populations for BSE to augment mandatory reporting of clinical suspects.

In Switzerland, the first case of bovine spongiform encephalopathy (BSE) was diagnosed in November 1990. Case numbers peaked in 1995, with a total of 352 BSE cases identified by 30 April 2000. Reporting of clinically suspect cattle is currently the most commonly used method world-wide to detect BSE cases. The effectiveness of mandatory reporting depends on a variety of factors; for other diseases passive surveillance underestimates the incidence of clinical cases. The efficiency of passive surveillance systems for BSE will remain unknown until screening tests able to identify clinically affected cattle have been applied in several countries. This paper provides the first detailed description of a targeted screening programme for BSE. Two populations of cows >24 months of age were included in the targeted screening: (i) cows found dead or culled on site where the carcass was submitted to rendering (fallen stock) and (ii) cows with health-related problems unfit for routine slaughter that were slaughtered under emergency procedures (emergency slaughter). Between 1992 and 1999, on average 81 clinical BSE suspects per year were reported to the veterinary authorities (passive surveillance), of which 43% were confirmed with BSE. A total of 30 clinical cases were captured by passive surveillance and an additional 20 BSE cases detected by targeted screening between May 1999 and April 2000. The odds of finding a BSE case was 49 times higher in the fallen stock and 58 times higher in emergency-slaughtered cattle when compared to passive surveillance. The targeted screening of fallen stock and emergency-slaughtered cattle considerably increased the number of detected cases in this 12-month period. Targeted-screening cases were on average 4 months younger than the clinical suspect cases. In conclusion, post-mortem testing of fallen stock and emergency-slaughtered cows >24 months for BSE is an important active surveillance element within a total surveillance system that principally is based on mandatory reporting of clinical suspect cases. Without ante-mortem screening tests to detect BSE-infected cattle during the incubation period, a combination of effectively functioning passive and active BSE surveillance strategies might be the only approach to assess the BSE situation reliably in a given country or region - and it is necessary to substantiate claims of freedom from the disease.

Animals↗