[Kidney and smoking: literature review and focus]

Smoking remains a major public health problem. It is associated with a considerable number of deaths in the world's population. Smoking is just like high blood pressure, an independent predictor of progression to any primary renal disease and renal transplant patients. It seems that smoking cessation slows the progression of kidney disease in smokers. The literature data are sometimes contradictory about it because of some methodological weaknesses. However, experimental models highlight the harmful effects of tobacco by hemodynamic and non-hemodynamic factors. The conclusion is that a major effort should be further produced by the nephrology community to motivate our patients to stop smoking.

Biphosphonate-associated osteonecrosis of the maxilla. Case report and review of the literature

In recent years, a growing number of reports in the literature have linked osteonecrosis of the jaw bones with intravenously administered bisphosphonates prescribed for the treatment of hypercalcemia of malignancy due to bone lesions of multiple myeloma or bone metastases in patients with breast or prostate cancer. Furthermore, an association between chronic oral bisphosphonate use in patients with osteoporosis or Paget's disease, and bone necrosis in the mandible or maxilla has been demonstrated in numerous case reports and case series in the last couple of years. Therapeutically, osteonecrosis of the jaws seems to be difficult to treat surgically, often resulting in a recurring or even progressing lesion. In the present case report of a bisphosphonate-associated osteonecrosis of the maxilla in a patient with osteoporosis, the current literature will be discussed, and open research questions and potential problems for our daily dental practice routine will be addressed.

Das Burnout-Syndrom: eine medizinische Perspektive

The burnout syndrome is a heterogeneous concept mostly understood as a complex of symptoms, primarily exhaustion, in response to prolonged emotional and interpersonal stress at work. The prevalence of burnout is considerably high in Swiss primary care physicians. In spite of its vague definition, burnout is a serious stress disease with many associated medical problems and high economic costs. Previous recommendations for the psychosomatic management of patients with functional somatic syndromes also apply to burnout treatment. These are complemented by more specific interventions targeting job stress related factors. Relapse prevention focuses on early recognition of warning signs and is an ongoing process.

[Collagenase injection in Dupuytren's disease, evaluation of the ultrasound assisted technique].

Since October 2011, the enzymatic lysis of Dupuytren's cord was introduced in Switzerland (Xiapex(®), Auxilium Pharmaceuticals, Pfizer). Here we present our first university experience and underline the major role of ultrasound during the injection. Between December 2011 and February 2013, 52 injections were performed to eliminate 43 Dupuytren's cords in 33 patients. The mean age of the patients was 64.4 ± 8.5 years. Complications were documented for each patient. Before, directly after and after a minimum of 6 months post-injection, the contracture of the treated joint was measured with use of a goniometer. The DASH score was evaluated after a minimum of 6 months and the patients were asked to subjectively evaluate the outcome of the treatment (very good, good, mild, poor) and whether they would reiterate it if necessary. Four skin defects, one lymphangitis, and one CRPS were responsible for a complication rate of 18%. There was no infection and no tendon rupture in the series. The mean MCP joint contracture was respectively 36.8 ± 27.4°, 3.5 ± 7.8° (gain of mobility compared to the preoperative situation 33.3°, P<0.001), and 8.4 ± 13.9° (gain 28.4°, P<0.001) respectively before, just after and at the long-term clinical control. The mean PIP joint contracture was respectively 36.5 ± 29.1°, 5.9 ± 6.7° (gain 30.6°, P<0.001), and 15.1 ± 13.8° (gain 21.4°, P<0.001) respectively before injection, just after and at the long-term clinical control. The DASH score decreased from 24 ± 14 to 7 ± 9 (P<0.001). Eighty-one per cent of the patients were satisfied or very satisfied of the treatment. All but two would reiterate the treatment if necessary. Ultrasound is able to target the injection of collagenase in order to reduce complications. The short-term results of this non-invasive therapy are very promising however comparison with conventional procedures is difficult as the long-term results are lacking.

Update chronische Hepatitis B und C

Der natürliche Verlauf einer HepatitisB-Virus(HBV)-Infektion ist komplex und wird einerseits durch das Alter zum Zeitpunkt der Infektion, anderseits durch Komorbiditäten bzw. Koinfektionen und zum Teil noch nicht identifizierte Faktoren bestimmt. Das HBV wird nie komplett eliminiert. Das Erreichen des inaktiven Trägerstatus ist aber ein realistisches Therapieziel. Zur Therapie stehen Nukleosid/NukleotidAnaloga sowie pegyliertes Interferonalpha zur Verfügung. Screening von bestimmten Patientengruppen und eine generelle Impfung sind wichtige prophylaktische Massnahmen. Die chronische Hepatitis-C-Virus(HCV) -Infektion führt in circa einem Drittel der Fälle zur Leberzirrhose. Eine Therapie ist generell ab Fibrosestadium Metavir 2 indiziert. Neue DAA (directly acting antivirals) erlauben kurzfristige, hochpotente und nebenwirkungsarme Therapieschemata.

[Transition in kidney transplantation]

Transition from pediatric to adult care in renal transplantation has emerged as a critical step in the life of a young kidney recipient. During this phase, young patients are faced with the physiological and psychological changes associated with adolescence that can lead to non-compliance and potentially graft loss. To date, there is not a unique accepted model of transition, however it has been proved that the presence of a multidisciplinary team including specialists in adolescent management and in the transition from pediatric to adult transplant care is beneficial during this at-risk phase. The goal of this team is to ensure a progressive transition of the patients according to a precise plan and time line.