Search

Hodgkin lymphoma (HL) in older patients appears to be a different disease compared with younger patients with historically lower survival rates. This is related to a variety of factors, including increased treatment‐related toxicity, the presence of comorbidities, and biologic differences. In order to better assess the clinical characteristics, treatment strategies, and outcome of this particular population, we conducted a population‐based, retrospective analysis including 269 patients with HL older than 60 years (median age 71 years, range 60–94), treated between 2000 and 2017 in 15 referral centers across Switzerland. Primary endpoints were overall survival (OS), progression‐free survival (PFS), and cause‐specific survival (CSS). The vast majority of patients were treated with curative intent, either with a combined modality approach (chemotherapy followed by radiation therapy) or with systemic therapy. At a median follow‐up of 6.6 years (95% confidence interval [CI], 6.0–7.6), 5‐year PFS was 52.2% (95% CI, 46.0–59.2), 5‐year OS was 62.5% (95% CI, 56.4–69.2), and 5‐year CSS was 85.1.8% (95% CI, 80.3–90.1) for the entire cohort. A significant difference in terms of CSS was observed for patients older than 71 years in comparison to patients aged 60–70 years (hazard ratio 2.6, 1.3–5.0, p = 0.005). Bleomycin‐induced lung toxicity (BLT) was documented in 26 patients (17.7%) out of the 147 patients exposed to this compound and was more frequent in patients older than 71 years (15/60, 25%). Outcome of HL pts older than 71 years appeared to decrease substantially in comparison to the younger counterpart. Treatment‐related toxicities appeared to be relevant, in particular, BLT. New, potentially less toxic strategies need to be investigated in prospective clinical trials in this particular frail population. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Periodontology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: In the treatment of advanced Hodgkin lymphoma (aHL), based on guidelines a multitude of treatment options are available. The availability of PET-guided decision-making and new therapeutic agents increase the complexity of the decision-making process., Methods: Thirteen experts of Swiss university and cantonal hospitals in Switzerland were asked to describe their institutional decision-making practice in aHL. Variables influencing the decision-making process were identified, standardized, and converted into decision trees for analysis of consent and discrepancies. The algorithms of all participating experts were analyzed with the objective consensus methodology., Results: Four decision criteria (age, fertility preservation, fitness, and interim PET) and 12 unique treatment regimens were identified. Consensus for the treatment of aHL for young and fit, as well as for older patients without comorbidity, was found. Large heterogeneity was identified with use of a variety of different regimens for unfit patients with aHL and for young female patients with a desire of fertility preservation., Conclusions: Four major decision criteria were identified allowing the representation of expert's approach to first-line treatment of aHL. Among Swiss experts, consensus for a PET-guided curative treatment of aHL was identified. The use of a multitude of treatment regimens was observed for older and comorbid (unfit) aHL patients, highlighting the need for clinical trials and recommendations for this group of patients., (© 2022 S. Karger AG, Basel.)

Status epilepticus (SE) is an important neurological emergency lacking adequate evidence for efficacy and safety of treatment beyond the application of benzodiazepines as first treatment step. To bridge the gap between the few pivotal trials and retrospective uncontrolled case series, we established a prospective multicenter registry recruiting patients in experienced centers in German-speaking countries. We could document 1179 episodes of 1049 patients over a period of 5 years. First data analysis showed that in the majority of the episodes, established treatment guidelines were not followed. Latency between status onset and different treatment steps were longer, and bolus doses lower than recommended. Moreover, a relevant proportion of the patients did not receive a benzodiazepine but levetiracetam as first treatment step. Although SE could be controlled in more than 90% of the episodes, lower bolus dose and longer treatment latency were associated with refractoriness of the SE in multivariate analysis. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To investigate the initial termination rate of status epilepticus (SE) in a large observational study and explore associated variables., Methods: Data of adults treated for SE were collected prospectively in centers in Germany, Austria, and Switzerland, during 4.5 years. Incident episodes of 1,049 patients were analyzed using uni- and multivariate statistics to determine factors predicting cessation of SE within 1 hour (for generalized convulsive SE [GCSE]) and 12 hours (for non-GCSE) of initiating treatment., Results: Median age at SE onset was 70 years; most frequent etiologies were remote (32%) and acute (31%). GCSE was documented in 43%. Median latency between SE onset and first treatment was 30 minutes in GCSE and 150 minutes in non-GCSE. The first intravenous compound was a benzodiazepine in 86% in GCSE and 73% in non-GCSE. Bolus doses of the first treatment step were lower than recommended by current guidelines in 76% of GCSE patients and 78% of non-GCSE patients. In 319 GCSE patients (70%), SE was ongoing 1 hour after initiating treatment and in 342 non-GCSE patients (58%) 12 hours after initiating treatment. Multivariate Cox regression demonstrated that use of benzodiazepines as first treatment step and a higher cumulative dose of anticonvulsants within the first period of treatment were associated with shorter time to cessation of SE for both groups., Interpretation: In clinical practice, treatment guidelines were not followed in a substantial proportion of patients. This underdosing correlated with lack of cessation of SE. Our data suggest that sufficiently dosed benzodiazepines should be used as a first treatment step. ANN NEUROL 2019;85:421-432., (© 2019 American Neurological Association.)

The present study analyzed the relationship between periodontal health adjacent to filled and unfilled tooth sites in young men (recruits). The status of oral health of 419 Swiss army recruits, aged 19 to 20 years was assessed by determining Plaque Index (PI), Retention Index (RI) and Gingival Index (GI) as well as Pocket Probing Depth (PPD) and Probing Attachment Loss (PAL). In addition, the level of alveolar bone was measured using digitized bite-wing radiographs with an enlargement of 4.5x. Filling margins were assessed and the distance between the alveolar bone crest and the cemento-enamel junction (CEJ) measured to the nearest one tenth of a millimeter. These data were compared with the clinical parameters. A total of 8'050 sites were examined. 765 or 9.5 of the sites in the posterior area were filled. 119 of them showed filling overhangs larger than 0.2 mm. Thus, 1.5 % of the examined sites had a significant overhanging margin. All clinical parameters had greater values at filled than at unfilled sites. The differences were statistically not significant. Even the sites with margins overhanging more than 0.8 mm (n=14) did not show significantly different parameters compared to unfilled sites. The comparison with a similar study involving recruits 11 years earlier assessed that the recruits of 1996 had less and smaller filling overhangs. This, in turn, means that, in Switzerland restorative dentistry in young males has been markedly improved during the 1980's and 1990's.

The aim of this study was to examine the distribution of typical periodontitis-associated microorganisms in refugees arriving from non-industrialized countries, and to relate the presence of these organisms to the periodontal condition of the subjects. Thirty males between 35-44 years of age were surveyed. Dental plaque, calculus, gingivitis, loss of attachment, and probing depths were recorded for all surfaces. A total of 90 microbiological samples were taken with paper points from mesial sites of teeth 16, 36 and 41. Microbiological test sites were grouped by probing depths and loss of attachment. Only 16.8% of all surfaces had probing depths > 3 mm, although 90.7% of surfaces had loss of attachment > 1 mm. Twenty-one sites with obvious periodontal destruction (PD > 3 mm, LA > 2 mm) showed the greatest recovery of Porphyromonas gingivalis (66.7%). However, 51 sites with minimal periodontal disease (PD < or = 3 mm, LA < 2 mm) and with no gingival recession also showed a relatively high detection frequency of P. gingivalis (34.1%). Twenty-four of these samples came from 12 patients with no pockets > 5 mm and with less than 10% of all sites yielding pockets > 3 mm. The detection frequencies of Prevotella intermedia (91.6%), Bacteroides forsythus (25.0%), Wolinella spp. (33.3%) and Actinobacillus actinomycetemcomitans (50.0%) were similar in these sites compared with periodontitis sites. Morphologically distinct isolates, from 19 individuals positive for A. actinomycetemcomitans, were serotyped by indirect immunofluorescence.(ABSTRACT TRUNCATED AT 250 WORDS)

An epidemiological survey in 12 cantons of Switzerland yielded a high percentage of all the sites examined with signs of gingivitis. Nevertheless, only 4% of all the sites showed periodontal breakdown of 7 mm or more; however, those sites were distributed in larger proportions of the population sample. Further frequency analysis revealed that more than 75% of the persons examined yielded no or only few sites with periodontal breakdown. The results of this study indicate that despite the high percentage of inflamed gingival units in the population, periodontal breakdown is less frequent than commonly estimated.

The purpose of this analysis was to assess the ability of the CPITN system to rate severity and prevalence of periodontal diseases in a population, in comparison with full mouth scorings using conventional clinical parameters (Plaque Index, Gingival Index, Retention Index, Pocket Probing Depth and Loss of Attachment). These parameters were collected in a randomly selected sample in Switzerland. The data were then transformed to fit the definitions of the CPITN. Furthermore, a comparison of the data set from Switzerland with data obtained from the Oral Global Data Bank of the WHO was made. By conversion of the Swiss data into the CPITN format, many details were lost, which were considered to be relevant to assess severity, prevalence and localization of periodontal diseases within a population. In addition, the transformed data generally overestimated the prevalence of periodontal destruction when compared with data from surveys in other industrialized countries in which the CPITN was used to evaluate the periodontal status. The comparison of the data before transformation into the CPITN, however, corroborated results from epidemiological studies in which conventional periodontal index systems were used. This indicates that data obtained to determine defined treatment needs (CPITN) may be of questionable value for the assessment of the true prevalence and severity of periodontal disease in a population.

Of 219 elderly patients admitted consecutively to a geriatric hospital in Switzerland, 59.4% were edentulous. A high proportion of the dentate patients exhibited tooth loss patterns requiring free-end partial dentures in the maxilla (36.0%) or the mandible (69.7%). Of the remaining teeth, 29.3% were decayed, and 45.1% had severe periodontitis. Virtually all (97.8%) dentate and 31.5% of the edentulous subjects were judged to need some kind of dental treatment. In contrast, the subjective need for dental treatment was low in dentate (30.4%) and edentulous (13.1%) subjects. Prosthesis hygiene was poor in 73.8% of the 191 denture wearers whether they needed assistance with oral hygiene or not. The objectively-assessed need for a new prosthesis in edentulous patients was determined by income, marital status, and patient mobility, whereas the need for a prosthesis alteration was related to cognitive function. These findings should help to plan future dental prophylactic and therapeutic services in geriatric hospitals.

The aim of the present study was to evaluate the periodontal conditions of a randomly selected population in the Canton of Berne, Switzerland. From a total of 350 selected persons, 206 (59%) attended the examinations. The Plaque Index (PlI), Gingival Index (GI) and Retention Index (RI), the width of the keratinized gingiva, pocket probing depth (PD) and loss of probing attachment (LA) were recorded on four surfaces per tooth in the entire dentition of the subjects. The statistical analyses were performed using the Statistical Analysis System (SAS). A total of 4253 teeth were scored. On average the patients had 20.7 teeth. The mean PlI of this population was 1.16, the mean GI was 1.34 and the mean RI was 0.81. All three indices were higher in older age groups. 72% of all measurements for pocket probing depths were less than or equal to 3 mm, 26% were between 4 and 6 mm, and only 2% were more than 6 mm. 76% of all sites had lost less than or equal to 3 mm of probing attachment, 21% of the sites had lost between 4 and 6 mm and only 3% had lost more than 6 mm. There were no statistically significant differences either between females and males or between the rural and the urban populations. These results indicate that only a relatively small percentage of the sample representative for the respective area in Switzerland suffered from advanced periodontitis, while the great majority may be treated by rather conservative approaches to periodontal therapy.

139 soldiers aged 28-32 years of a medical corps unit of the Swiss army were examined for their periodontal conditions. On 3 surfaces of all teeth, plaque deposits were assessed according to the Plaque Index System (Silness and Löe, 1964) and gingival health determined according to the Gingival Index System (Löe and Silness, 1963). Calculus deposits were evaluated on the 6 representative teeth of Ramfjord (1959). On 4 surfaces of the same teeth, pocket depths and loss of attachment were measured. The mean P1I was 1.38, the mean GI 1.11. The mean pocket depth was 2.52, and the mean loss of attachment was 1.38. The results of this study were compared with those of a previous study by Curilović et al. (1972). It was concluded that periodontal disease progressed in the Swiss male population between 20 and 30 years at an annual rate of 0.18 mm loss of attachment despite all the efforts in preventive dentistry.

139 medical corps soldiers (aged 28-32 years) of the Swiss army were interviewed for their oral hygiene habits. The same questionnaire as that described by Saxer et al. (1972) was used in order to compare the results of the present study with those obtained by Saxer et al. (1972) in an army basic training school in Zurich. The attitude of the soldiers towards their dentist did not change when compared to that of the recruits. However, the soldiers tended to be more "tooth conscious" than the recruits. They also showed a better attitude for oral hygiene procedures and greater knowledge concerning periodontal disease.

Recently it has been shown that there is a high prevalence of treatable dental conditions in elderly subjects in Switzerland. The purpose of the present prospective study was to assess the value of an oral screening examination intended to help the primary care physician to determine which patients should be referred to a dental service for specialized treatment. Of 219 patients aged over 65 referred consecutively to a geriatric hospital, 58.4% were objectively in need of dental treatment according to the data obtained by a dentist. In a multiple logistic analysis, 4 oral screening criteria (presence of residual teeth of the patient's own, no prosthetic replacement of an edentulous arch, subjective dental treatment requirement, subjective chewing impairment) were found to predict the objectively assessed dental need with a sensitivity of 93.0% and a specificity of 82.4%. Among the patients with objective dental treatment requirement not predicted by the screening examination, 3 had ulcerations of the oral mucosa. An intraoral soft-tissue examination should therefore be included in the screening examination. In conclusion, simple oral screening may serve to identify patients needing dental care with a high degree of diagnostic accuracy. This enables the primary care physicians to screen for oral and dental problems and to refer patients in the same way as for other special treatment problems.

To plan a dental care program for geriatric patients, the dental treatment needs of 219 elderly patients consecutively admitted to a geriatric hospital were quantitatively assessed. Of 89 patients with residual teeth, 97.8% were assessed as needing dental treatment of a mean projected duration of about 312 min per patient. Of the 130 edentulous patients, 30.8% needed dental treatment of a mean projected duration of about 194 min per patient. Patients exhibiting high (greater than 60 min) dental treatment needs were more frequently impaired in activities of daily living than patients with low (less than or equal to 60 min) dental treatment needs (e.g. impaired transfer function 60.2% vs. 28.0%). There was no difference in the oral hygiene or in the cleanliness of removable dentures between patients needing and not needing help in activities of daily living. In conclusion, the present results show a high amount of dental treatment needed in elderly patients. For the planning of an effective dental care program, special attention has to be paid to the interdisciplinary treatment of patients with limitations in activities of daily living. Furthermore, the improvement of the oral hygiene status is of paramount importance in most elderly patients.