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Biomedical subjects

P Wyss

Publications and source records attributed to P Wyss.

54 records · Page 3Linked to original sources
PubMed1993

[The risk of conception during lactation].

The contraceptive effect of lactation is undisputed. Nursing increases the prolactin level in the serum. This hyperprolactinaemia suppresses all levels of the hypothalamus-hypophysis-ovary axis. The risk of ovulation can be greatly reduced by a proper nursing routine, frequency of nursing being credited with a greater anovulatory effect than duration of nursing. In addition, full nursing increases contraceptive safety. To prevent a drop in the serum prolactin level, nursing should also be done at night-time. Amenorrhoea during the lactation period is one of the most important prerequisites for an adequate contraception. The risk of ovulation increases dramatically, if vaginal bleeding occurs. However, the first cycles in the lactation period are often anovular and characterized by corpus luteum insufficiency. Lactation-induced amenorrhoea, nursing frequency of at least 6 x/day, nursing duration of at least 60 minutes/day, additional feedings of maximum 1 x/day and nocturnal nursing are the requirements for sufficient nursing-induced contraception. Even if these requirements are fulfilled, the risk of ovulation increases with the length of time post partum. Effective contraceptive protection is attained only up to the 9th p.p. week. If high post partum contraceptive safety is required, a mini-pill or micro-pill must be recommended. Lactation can only be recommended as a moderate contraceptive measure even in this case, an additional method (chemico-mechanical) should be initiated 3 months post partum.

Adult↗
PubMed1993

[Mononeuritis multiplex as initial manifestation of systemic granulomatosis].

We report two young patients with a painful and rapidly progressive polyneuropathy of the mononeuritis multiplex type confiding them to bed. Extensive investigations led to the diagnosis of a granulomatosis in both: Churg-Strauss allergic granulomatosis in one and Wegener's granulomatosis in the other. The importance and frequency of peripheral nervous system manifestations in the presenting clinical pattern of a systemic granulomatosis and vasculitis are discussed. Their proper recognition with regard to available effective therapeutic measures is stressed.

Adult↗
PubMed1992

[Spinal lesions in surgery of the aorta].

Aortic diseases in particular aneurysms may be accompanied by spinal ischemia occurring either spontaneously or as complications of surgical interventions. Surgery of the abdominal or thoraco-abdominal aorta is followed in 5 to 15% by ischemia of the spinal cord, in exclusively abdominal interventions in 1.5%. Clinical manifestation depends largely on anatomy of the spinal vessels. If complete transverse myelopathy does not occur, presentation as anterior or posterior arterial ischemic syndrome is common. Other forms of myelopathy are rare. Perfusion deficits through intercostal and lumbar arteries are important in pathogenesis. The great radicular artery is particularly important. Ischemia occurs after hypotensive episodes (ruptured aneurysm) intraoperative clamping of the suprarenal aorta or by occlusion (thrombotic, arterio-arterial embolism). Careful surgical techniques are important for prevention of these neurologic complications. Possibilities for treatment and chances for spontaneous recovery of established spinal-cord lesions are poor.

Aorta↗
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↗
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↗
PubMed1990

Primary lipid cardiomyopathy.

In this communication, we describe an isolated, apparently congenital cardiomyopathy (CMP) characterized by the accumulation of stainable lipid in mitochondria of cardiomyocytes. This lesion, which we term primary lipid cardiomyopathy, has not been reported so far. The structural alteration was associated with progressive heart failure, leading to death at the age of 3 years, and with massive hypertrophy of myocardium. Lipid storage in heart muscle cells resulted in an impressive yellow to orange color of the myocardium. We suggest that this type of primary CMP may represent a new member within the group of mitochondrial CMPs. Possible pathogenic mechanisms are discussed.

Cardiomyopathies↗
PubMed1986

Anatomy of the veins of the dorsum pedis with regard to their suitability as vascular grafts in reconstructive microsurgery.

Attempts to locate veins suitable as micro-surgical vascular grafts were carried out in 16 preparations of the subcutaneous venous network of the dorsum pedis. For this reason the length, diameter, valve distances and frequency of longitudinal veins were especially examined. Four types of veins were defined as being suitable for transplantation and it was established that they are situated in the medial half of the dorsum pedis in the so-called microsurgical area in all cases. Collecting and conducting veins can be distinguished by means of the location of the valves, which are generally bicuspidal. In most cases, the level of the opening spaces of both the segment and the opening valves lies parallel to the surface of the skin.

Humans↗
PubMed1975

[Infusion treatment in severe dehydration (infantile toxicosis)].

Severe dehydration in infants is a common life threatening condition. The therapy of different forms of dehydration has been described. Many practical suggestions for diagnostic procedures have been added. Clinical and pathophysiological peculiarities typical of the treatment of severe infantile dehydration have been stressed.

Alkalosis↗
PubMed1975

[Schizophreniform conditions in adolescent drug users differentiation possibilities using objective personality inventories].

The authors report on schizophreniform states in juvenile drug consumers. The following psychodiagnostic instruments have been used in this investigation: a list of complaints, a self-estimation scale, a psychosis-depression-neurosis inventory (v. Zerssen), the Freiburg personality inventory (FPI, Fahrenberg, Selg and Hampel). According to clinical-psychopathological data in the course of psychosis, three groups of patients (N = 21) have been formed and defined as schizophrenia-, borderline-, intoxication-psychosis-groups. The report describes the procedure of two discriminant analyses by which the said three groups have been selected. In addition to methods of a cross section approach, the necessity of longitudinal observations is discussed by means of an own clinical example, considering also observations described in the literature.

Adolescent↗
PubMedDate not supplied

Cost-effectiveness studies in ovarian cancer.

Ovarian cancer is the fifth leading cause of cancer-related deaths. The costs associated with this cancer impact both on the affected individual and on the health system. Screening is currently unproven as a strategy for improving outcomes for women with ovarian cancer. Randomized controlled trials, however, are underway, estimating any impact of screening with ultrasound and CA125 on ovarian cancer mortality. Paclitaxel and carboplatin combination, the standard first-line chemotherapy regimen for ovarian cancer, has not been compared with cisplatin and cyclophosphamide regarding the cost-effectiveness and cost-utility, but for paclitaxel and cisplatin, numerous studies have addressed these issues. The estimated incremental costs resulting from these studies fall well within the generally accepted range for new therapies. Although acquisition costs of new chemotherapy drugs exceed those of older drugs, the impact of costly drugs on total costs may be cost saving due to less costs related to supportive and palliative care. The most important costs for the patient, the pain and suffering associated with ovarian cancer and its treatment, are hard to quantify. Nevertheless, patients' quality of life must be considered when making a clinical decision to treat this disease. A review of available cost-effectiveness studies is presented and discussed.

Antineoplastic Agents↗
PubMedDate not supplied

[Sodium concentration and pre-eclampsia: is salt restriction of value?].

UNLABELLED: The significance of sodium metabolism with respect to preeclampsia is discussed in the literature with a wide range of diverging opinions. The presented work analyses the influence of a low salt diet on the symptoms of preeclampsia and the consequences for the newborn. MATERIAL AND METHODS: 160 patients with preeclampsia between 1989 and 1993 were retrospectively studied. Serum sodium values (at hospital admission, lowest prepartal level, immediate and 3-8 days postpartum) were compared with the corresponding gestosis symptoms. RESULTS: The mean sodium serum concentration at admission was 135.6 mmol/l (lower norm: 136 mmol/l). This was significantly different from the mean lowest prepartal value of 134.9 mmol/l (p < 0.0001). Postpartum the mean fell again significantly to 134.0 mmol/l (p < 0.0001). None of the parameters for gestosis symptoms, which were investigated (diastolic blood pressure, edema, proteinuria, serum protein levels and hyperreflexia) showed any statistically significant association with the serum sodium concentration. Five patients had very low serum natrium values, 130 mmol/l, either at admission or during hospitalisation. Three of the five infants of these patients had hyponatremia; two needed sodium supplementation. CONCLUSION: There seems to be no reason supporting a low salt diet as therapy for preeclampsia, since it does not affect the symptoms and might lead to hyponatremia in the newborn.

Adult↗