Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 11 de 11
Filter
1.
Medicines (Basel) ; 9(12)2022 Dec 16.
Article in English | MEDLINE | ID: mdl-36547997

ABSTRACT

BACKGROUND: Considering present concerns about healthcare costs and the lack of evidence and published articles on breast reconstruction costs in Switzerland, we retrospectively investigated charges to the Swiss healthcare system for different breast reconstruction procedures at the Centre Hospitalier Universitaire Vaudois. METHODS: We selected all hospitalized patients at the University Hospital who underwent a "total" delayed breast reconstruction from January 2012 to December 2015. Analysis included 72 women who underwent autologous or implant-based reconstructions. Three main breast reconstruction techniques were included: Deep Inferior Epigastric Perforator (n = 46) autologous flap reconstruction, Tissue Expander followed by Implant (n = 12) and pedicled Latissimus Dorsi (n = 12) flap with or without tissue expander and implant (n = 7). For all different groups, the global costs of reconstruction and total number of required operations were statistically compared. RESULTS: Global costs for Deep Inferior Epigastric Perforator reconstruction were 29,728 ± 1892 CHF (avg ± Std. Error of Mean), while Tissue Expander reconstruction showed a significantly higher global cost, reaching an average of 44,313 ± 5553 CHF (avg ± Std. Error of Mean). LD showed a similar cost, compared to the Deep Inferior Epigastric Perforator reconstruction (29,813 ± 3637 CHF), increasing when including an implant (37,688 ± 4840 CHF). No significant differences in the number of interventions were detected. CONCLUSION: These data show that autologous breast reconstruction (DIEP) delivers the best cost ratio, with lower overall costs. Implant-based reconstructions showed a greater likelihood of complications and re-intervention, globally creating superior costs when compared to autologous reconstructions.

2.
Rev Med Suisse ; 16(706): 1721, 2020 09 16.
Article in French | MEDLINE | ID: mdl-32936559
3.
Am J Transplant ; 19(11): 3191-3196, 2019 11.
Article in English | MEDLINE | ID: mdl-31344327

ABSTRACT

A 65-year-old man had extensive burns of the lower legs in 1991, at the age of 40 years. He was treated by nonvascularized and de-epithelialized, allogeneic split-thickness skin allograft and cyclosporine monotherapy for 2 months. Ulcers developed between 10 and 25 years after transplantation and a surgical debridement on the lower extremities was required. Analyses of the removed tissue allografts showed chronic antibody-mediated and cellular rejection with extensive and dense fibrosis, and diffuse capillary C4d deposits. An anti-DRB1*08:01, donor-specific antibody was present. A unique clinical condition with late immunopathological features of human skin chronic allograft rejection is reported.


Subject(s)
Burns/therapy , Graft Rejection/diagnosis , Isoantibodies/adverse effects , Neovascularization, Pathologic/diagnosis , Skin Transplantation/adverse effects , Aged , Chronic Disease , Graft Rejection/etiology , Graft Survival , Humans , Male , Neovascularization, Pathologic/etiology , Prognosis , Risk Factors , Transplantation, Homologous
4.
Praxis (Bern 1994) ; 107(20): 1081-1084, 2018.
Article in French | MEDLINE | ID: mdl-30278846

ABSTRACT

Surgical Treatment for Lipedema Abstract. Lipedema is a progressive disease that occurs in adolescence and affects one in nine women. The signs are limited to the lower limbs. Early signs are nonspecific, which is why the diagnosis is often ignored. Later, pain and heaviness of lower limbs become predominant. Finally, at an advanced stage, tissue fibrosis is associated with significant edema. At this stage, patients become severely disabled and bedridden. At the early stage, the treatment is conservative. Liposuction is indicated at the onset of pain. Its effectiveness pain and long-term control has been demonstrated on. Finally, late stages require heavy and complex surgeries combining dermolipectomy and liposuction.


Subject(s)
Lipectomy/methods , Lipedema/surgery , Adolescent , Adult , Combined Modality Therapy , Early Diagnosis , Early Medical Intervention , Female , Humans , Lipedema/classification , Lipedema/diagnosis , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Risk Factors , Young Adult
5.
Rev Med Suisse ; 13(584): 2023-2026, 2017 Nov 22.
Article in French | MEDLINE | ID: mdl-29165937

ABSTRACT

Job sharing is a promising way of organizing work : it allows physicians wishing to work part-time to access jobs that are usually inaccessible to them, while offering hospitals the possibility to recruit or retain qualified physicians to ensure succession planning. This article describes the advantages and the main challenges of jobsharing in a medical department. It provides concrete guidance to physicians wishing to practice it, to contribute to its dissemination. Jobsharing it is a way of organizing work that is practicable and safe in hospitals, provided that partners have compatible values and vision, respect therapeutic attitudes taken by the partner and optimally coordinate their work.


Le partage d'emploi ou jobsharing est un mode d'organisation du travail prometteur : il permet aux médecins souhaitant travailler à temps partiel d'accéder à des postes habituellement inaccessibles, tout en offrant à l'hôpital la possibilité de recruter ou retenir des médecins compétents pour assurer la relève. Cet article décrit les avantages et les défis principaux du partage d'emploi dans un département de médecine. Il donne des pistes concrètes pour les médecins souhaitant travailler ainsi, pour contribuer à sa diffusion. Les expériences montrent que le partage d'emploi est un mode d'organisation du travail praticable et sûr en milieu hospitalier, à condition que les partenaires aient des valeurs et une vision compatibles, respectent les attitudes thérapeutiques prises par le partenaire et se coordonnent de façon optimale.


Subject(s)
Hospitals, University , Physicians , Career Mobility , Hospital Departments
6.
Rev Med Suisse ; 12(505): 318-21, 2016 Feb 10.
Article in French | MEDLINE | ID: mdl-27039446

ABSTRACT

We report the case of a 65years old patient followed for more than 4 years for a leg ulcer in whom a rare combination of pyoderma gangrenosum with breast cancer was diagnosed. This is a rare skin disease, usually associated with systemic disease: digestive, rheumatological or malignant. The diagnosis is mainly clinical. Taking patient diagnostic management has two objectives: to eliminate other causes of skin ulcer and determine whether there is a concomitant illness that can be treated. Bacteriological swab and a biopsy should always be performed. The treatment consists of topical corticosteroids and systemic therapy with corticosteroids or immunosuppressive agents.


Subject(s)
Breast Neoplasms/complications , Leg Ulcer/etiology , Pyoderma Gangrenosum/etiology , Aged , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Chronic Disease , Diagnostic Errors , Female , Humans , Leg Ulcer/diagnosis , Leg Ulcer/therapy , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/therapy , Skin Transplantation
7.
J Surg Case Rep ; 2015(2)2015 Feb 10.
Article in English | MEDLINE | ID: mdl-25672974

ABSTRACT

Propionibacterium avidum is a common inhabitant of sebaceous glands, traditionally considered to be of low virulence and generally found on implanted foreign material. We report a rare case of P. avidum breast abscess, causing severe morbidity following breast reduction surgery. A 36-year-old woman presented with a non-painful wound discharge 3 weeks postoperatively, and was treated conservatively. She was readmitted 7 weeks postoperatively with a red and tender breast. A purulent discharging abscess was drained under ultrasound guidance. A 2-week intravenous course of amoxicillin-clavulanic acid, followed by oral replacement for a month resulted effective. Serial ultrasound imaging was useful in treatment decision-making. The infective potential of P. avidum may be underappreciated. Proximity of sutures to the axilla, tobacco smoking and the potential for resorbable sutures to host bacteria may predispose to infection, and should raise the clinician's awareness.

8.
Early Interv Psychiatry ; 7(1): 94-9, 2013 Feb.
Article in English | MEDLINE | ID: mdl-22765257

ABSTRACT

AIM: The study aims to evaluate the effects of assertive community treatment (ACT) on the mental health and overall functioning of adolescents suffering from severe psychiatric disorders and who refuse any traditional child psychiatric care. There are a few studies evaluating the effects of ACT on a population of adolescents with psychiatric disorders. This short report highlights the impact of an ACT programme tailored to the needs of these patients, not only as an alternative to hospitalization, but also as a new form of intervention for patients that are difficult to engage. METHODS: The effect of ACT on 35 adolescents using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) as a measuring tool in pre- and post-intervention was evaluated. RESULTS: The results show that the intervention was associated with a significant improvement on the HoNOSCA overall score, with the following items showing significant amelioration: hyperactivity/focus problems, non-organic somatic symptoms, emotional symptoms, scholastic/language skills, peer relationships, family relationships and school attendance. CONCLUSION: ACT appears as a feasible intervention for hard-to-engage adolescents suffering from psychiatric disorders. The intervention seems to improve their mental health and functioning. This pilot study may serve as a basis to prepare a controlled study that will also take the costs of the intervention into account.


Subject(s)
Adolescent Behavior/psychology , Case Management , Community Mental Health Services/methods , Mental Disorders/therapy , Adolescent , Female , Humans , Male , Pilot Projects
9.
Rev Med Suisse ; 8(359): 2003-4, 2006, 2012 Oct 24.
Article in French | MEDLINE | ID: mdl-23167073

ABSTRACT

Reconstructive surgery takes an important place in breast cancer treatment. Immediate breast reconstruction is performed during the same operation as mastectomy. It is contraindicated following radiotherapy. Reconstruction performed after mastectomy is called differed breast reconstruction. It is completed 6 months after chemotherapy and 1 year after radiotherapy. Prosthetic breast reconstruction is indicated when tissues are of good qualities and breast are small. Autologous reconstruction is performed in case of radiotherapy or large breast. After breast reconstruction, imperfections can be corrected with autologous fat injection.


Subject(s)
Mammaplasty/methods , Adipose Tissue/transplantation , Breast Implants , Female , Humans , Mastectomy , Perforator Flap
10.
Skin Res Technol ; 18(4): 456-61, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22332947

ABSTRACT

BACKGROUND: Deep burn assessment made by clinical evaluation has an accuracy varying between 60% and 80% and will determine if a burn injury will need tangential excision and skin grafting or if it will be able to heal spontaneously. Laser Doppler Imaging (LDI) techniques allow an improved burn depth assessment but their use is limited by the time-consuming image acquisition which may take up to 6 min per image. METHODS: To evaluate the effectiveness and reliability of a newly developed full-field LDI technology, 15 consecutive patients presenting with intermediate depth burns were assessed both clinically and by FluxExplorer LDI technology. Comparison between the two methods of assessment was carried out. RESULTS: Image acquisition was done within 6 s. FluxEXPLORER LDI technology achieved a significantly improved accuracy of burn depth assessment compared to the clinical judgement performed by board certified plastic and reconstructive surgeons (P < 0.05, 93% of correctly assessed burns injuries vs. 80% for clinical assessment). CONCLUSION: Technological improvements of LDI technology leading to a decreased image acquisition time and reliable burn depth assessment allow the routine use of such devices in the acute setting of burn care without interfering with the patient's treatment. Rapid and reliable LDI technology may assist clinicians in burn depth assessment and may limit the morbidity of burn patients through a minimization of the area of surgical debridement. Future technological improvements allowing the miniaturization of the device will further ease its clinical application.


Subject(s)
Burns/diagnosis , Image Enhancement/instrumentation , Image Enhancement/methods , Laser-Doppler Flowmetry/instrumentation , Laser-Doppler Flowmetry/methods , Skin/injuries , Skin/pathology , Adolescent , Adult , Aged , Equipment Design , Equipment Failure Analysis , Humans , Middle Aged , Reproducibility of Results , Sensitivity and Specificity , Young Adult
11.
Burns ; 36(5): 639-46, 2010 Aug.
Article in English | MEDLINE | ID: mdl-19880257

ABSTRACT

BACKGROUND: Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs. METHODS: All patients admitted to the ICU, aged >18 years, with an ICU stay >24h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area. FINDINGS: Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36+/-14 years old and burned 27+/-15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24h (p<0.0001) followed by a later reduction with lower pain scores (p<0.0001), less procedural related anxiety, less procedures under anaesthesia, reduced total grafting requirements (p=0.014), and lower hospital costs per patient. CONCLUSION: A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits.


Subject(s)
Burns/complications , Burns/therapy , Hypnosis , Pain Management , Adolescent , Adult , Aged , Analgesics, Opioid/therapeutic use , Analysis of Variance , Blood Pressure , Burns/physiopathology , Female , Health Care Costs , Heart Rate , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Pain/economics , Pain/physiopathology , Pain Measurement , Skin Transplantation/statistics & numerical data , Wound Healing/physiology , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL
...