Clinical predictors of prophylaxis use prior to the onset of acute venous thromboembolism in hospitalized patients SWIss Venous ThromboEmbolism Registry (SWIVTER)

BACKGROUND: We investigated clinical predictors of appropriate prophylaxis prior to the onset of venous thromboembolism (VTE). METHODS: In 14 Swiss hospitals, 567 consecutive patients (306 medical, 261 surgical) with acute VTE and hospitalization < 30 days prior to the VTE event were enrolled. RESULTS: Prophylaxis was used in 329 (58%) patients within 30 days prior to the VTE event. Among the medical patients, 146 (48%) received prophylaxis, and among the surgical patients, 183 (70%) received prophylaxis (P < 0.001). The indication for prophylaxis was present in 262 (86%) medical patients and in 217 (83%) surgical patients. Among the patients with an indication for prophylaxis, 135 (52%) of the medical patients and 165 (76%) of the surgical patients received prophylaxis (P < 0.001). Admission to the intensive care unit [odds ratio (OR) 3.28, 95% confidence interval (CI) 1.94-5.57], recent surgery (OR 2.28, 95% CI 1.51-3.44), bed rest > 3 days (OR 2.12, 95% CI 1.45-3.09), obesity (OR 2.01, 95% CI 1.03-3.90), prior deep vein thrombosis (OR 1.71, 95% CI 1.31-2.24) and prior pulmonary embolism (OR 1.54, 95% CI 1.05-2.26) were independent predictors of prophylaxis. In contrast, cancer (OR 1.06, 95% CI 0.89-1.25), age (OR 0.99, 95% CI 0.98-1.01), acute heart failure (OR 1.13, 95% CI 0.79-1.63) and acute respiratory failure (OR 1.19, 95% CI 0.89-1.59) were not predictive of prophylaxis. CONCLUSIONS: Although an indication for prophylaxis was present in most patients who suffered acute VTE, almost half did not receive any form of prophylaxis. Future efforts should focus on the improvement of prophylaxis for hospitalized patients, particularly in patients with cancer, acute heart or respiratory failure, and in the elderly.

Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study

OBJECTIVES: To analyze computer-assisted diagnostics and virtual implant planning and to evaluate the indication for template-guided flapless surgery and immediate loading in the rehabilitation of the edentulous maxilla. MATERIALS AND METHODS: Forty patients with an edentulous maxilla were selected for this study. The three-dimensional analysis and virtual implant planning was performed with the NobelGuide software program (Nobel Biocare, Göteborg, Sweden). Prior to the computer tomography aesthetics and functional aspects were checked clinically. Either a well-fitting denture or an optimized prosthetic setup was used and then converted to a radiographic template. This allowed for a computer-guided analysis of the jaw together with the prosthesis. Accordingly, the best implant position was determined in relation to the bone structure and prospective tooth position. For all jaws, the hypothetical indication for (1) four implants with a bar overdenture and (2) six implants with a simple fixed prosthesis were planned. The planning of the optimized implant position was then analyzed as follows: the number of implants was calculated that could be placed in sufficient quantity of bone. Additional surgical procedures (guided bone regeneration, sinus floor elevation) that would be necessary due the reduced bone quality and quantity were identified. The indication of template-guided, flapless surgery or an immediate loaded protocol was evaluated. RESULTS: Model (a) - bar overdentures: for 28 patients (70%), all four implants could be placed in sufficient bone (total 112 implants). Thus, a full, flapless procedure could be suggested. For six patients (15%), sufficient bone was not available for any of their planned implants. The remaining six patients had exhibited a combination of sufficient or insufficient bone. Model (b) - simple fixed prosthesis: for 12 patients (30%), all six implants could be placed in sufficient bone (total 72 implants). Thus, a full, flapless procedure could be suggested. For seven patients (17%), sufficient bone was not available for any of their planned implants. The remaining 21 patients had exhibited a combination of sufficient or insufficient bone. DISCUSSION: In the maxilla, advanced atrophy is often observed, and implant placement becomes difficult or impossible. Thus, flapless surgery or an immediate loading protocol can be performed just in a selected number of patients. Nevertheless, the use of a computer program for prosthetically driven implant planning is highly efficient and safe. The three-dimensional view of the maxilla allows the determination of the best implant position, the optimization of the implant axis, and the definition of the best surgical and prosthetic solution for the patient. Thus, a protocol that combines a computer-guided technique with conventional surgical procedures becomes a promising option, which needs to be further evaluated and improved.

Little-known Swiss contributions to the description, diagnosis, and surgery of lumbar disc disease before the Mixter and Barr era

The understanding of lumbar spine pathologies made substantial progress at the turn of the twentieth century. The authors review the original publication of Otto Veraguth in 1929 reporting on the successful resection of a herniated lumbar disc, published exclusively in the German language. His early report is put into the historical context, and its impact on the understanding of pathologies of the intervertebral disc (IVD) is estimated. The Swiss surgeon and Nobel Prize laureate Emil Theodor Kocher was among the first physicians to describe the traumatic rupture of the IVD in 1896. As early as 1909 Oppenheim and Krause published 2 case reports on surgery for a herniated lumbar disc. Goldthwait was the first physician to delineate the etiopathogenes is between annulus rupture, symptoms of sciatica, and neurological signs in his publication of 1911. Further publications by Middleton and Teacher in 1911 and Schmorl in 1929 added to the understanding of lumbar spinal pathologies. In 1929, the Swiss neurologist Veraguth (surgery performed by Hans Brun) and the American neurosurgeon Walter Edward Dandy both published their early experiences with the surgical therapy of a herniated lumbar disc. Veraguth's contribution, however, has not been appreciated internationally to date. The causal relationship between lumbar disc pathology and sciatica remained uncertain for some years to come. The causal relationship was not confirmed until Mixter and Barr's landmark paper in 1934 describing the association of sciatica and lumbar disc herniation, after which the surgical treatment became increasingly popular. Veraguth was among the first physicians to report on the clinical course of a patient with successful resection of a herniated lumbar disc. His observations should be acknowledged in view of the limited experience and literature on this ailment at that time.

Handkommentar zum Schweizerischen Zivilgesetzbuch

Die zweite Auflage des Kommentars zum Zivilgesetzbuch aktualisiert und optimiert die in ihrer Kürze und Prägnanz überzeugende Erstauflage. Sie berücksichtigt nicht nur die mit der Schweizerischen Zivilprozessordnung verbundenen Änderungen des ZGB, sondern enthält auch die Kommentierung des neuen Erwachsenenschutzrechts und des neuen Immobiliarsachen- und Grundbuchrechts. Die Neuauflage erweist sich damit auf dem neusten Stand der Gesetzgebung. Konzeptionell ist der Band entsprechend dem OR-Kommentar aufgebaut; er enthält ein enges Zusammenspiel von Gesetzestext und Kommentierung, was eine rasche und intensive Auseinandersetzung mit der Materie erlaubt. Änderungen bei den im Buch enthaltenen Erlassen können abgerufen werden unter: www.navigator.ch/updates

Handkommentar zum Obligationenrecht

Die in ihrer Kürze und Prägnanz überzeugende Erstauflage des OR-Handkommentars wird mit dem Erscheinen der Zweitauflage aktualisiert, optimiert und vervollständigt.Die Zweitauflage berücksichtigt die seit 2001 in Kraft getretenen Gesetzesänderungen (insbesondere das neue GmbH-Recht) und erfährt mit der Kommentierung der Innominatkontrakte eine wertvolle Erweiterung. Das enge Zusammenspiel von Gesetzestext und Kommentierung erlaubt eine rasche und intensive Auseinandersetzung mit der Materie. Die Verarbeitung aktueller Rechtsprechung durch die in der Advokatur, an Gerichten, Universitäten und in Unternehmen tätigen Autoren unterstreicht den Praxisbezug.Der Leserschaft wird eine kompakt kommentierte und damit leicht zugängliche Aufarbeitung des gesamten Obligationenrechts präsentiert.

Schnitte, Knoten und Netze – 100 Jahre Schweizerische Gesellschaft für Chirurgie

Vom Nobelpreis für die Schilddrüsenoperation zur Osteosynthese als weltweit praktizierter Technik: Die Chirurgie in der Schweiz der letzten einhundert Jahre kann als Erfolgsgeschichte gelesen werden. Der Sammelband zum 100-Jahr-Jubiläum der Schweizerischen Gesellschaft für Chirurgie geht tiefer und analysiert in vier medizinhistorischen Detailstudien die Hintergründe von medizinischen Erfolgen und organisatorischen Herausforderungen. Einige Reflexionen beleuchten zudem die heutige Chirurgie von der Ökonomisierung bis zur neueren Sakralisierung des von Chirurgen behandelten Körpers. Beiträge aus der chirurgischen Praxis skizzieren technisch-therapeutische Trends dieses Faches von der Organtransplantation bis zur «Schlüsselloch-Chirurgie».

Politique étrangère suisse

Le conseiller fédéral Didier Burkhalter a pris la direction du Département fédéral des affaires étrangères (DFAE). – Le parlement a octroyé un crédit de 11.35 milliards de francs pour la coopération internationale 2013-2016. – Le Conseil fédéral a activé la clause de sauvegarde envers les Etats de l’UE-8. – Les questions institutionnelles ont continué à bloquer les relations bilatérales avec l’UE. – L’Allemagne et les Etats-Unis ont maintenu la pression sur la place financière suisse lors des négociations d’accords de double-imposition. – Le peuple a refusé l’initiative de l’ASIN « La parole au peuple ! ». – La Suisse a pris position sur le conflit syrien en instaurant des sanctions contre le régime. – La Suisse a fêté ses 10 ans d’adhésion à l’ONU et a reçu son secrétaire général Ban Ki-Moon. – La Suisse a accueilli à Berne le Prix Nobel de la Paix Aung San Suu Kyi et a ouvert une ambassade au Myanmar.