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Start Over Author "Patrick Hohlfeld" Journal swiss medical weekly
3 results on '"Patrick Hohlfeld"'

1. Interstitial pregnancies' diagnosis and management: an eleven cases series

Author

Anna Surbone, Olivier Cottier, Yvan Vial, Katyuska Francini, Patrick Hohlfeld, and Chahin Achtari

Subjects
beta-HCG, Interstitial pregnancy, intracornual methotrexate, intramuscular methotrexate, Laparoscopy, Medicine
Abstract

PRINCIPLES: Interstitial pregnancy represents 2% of ectopic pregnancies, but it is a highly morbid condition with a 2.5% of maternal mortality. Its diagnostic and therapeutic management remains controversial. The aim of this review is to describe the management of interstitial pregnancy in our institution between 2001 and 2011 and to define some general rules for the clinical practice. METHODS: Single institution retrospective study. RESULTS: Eleven women were treated for interstitial pregnancy. The median age was 33 years and the median gestity was 4. Seven patients had a history of gynaecological surgery and four interstitial pregnancies followed in vitro fertilisation. The diagnosis was made at a median gestational age of seven weeks with a median beta-HCG level of 5,838 U/l. Six of the eleven patients received an initial treatment with intracornual methotrexate, three with intramuscular methotrexate and two with surgery. The median time to beta-HCG resolution was 58 days. Three of the eleven patients needed a second line treatment: two after intramuscular methotrexate and one after intracornual methotrexate. Six patients had further pregnancies and delivered by caesarean section. CONCLUSIONS: A high prevalence of previous ectopic pregnancies, gynaecological surgery and of pregnancies resulting from in vitro fertilisation was observed. The earliness of the diagnosis was the factor that allowed a conservative treatment in most cases. Beta-HCG level follow up was fundamental in allowing a second line therapy but beta-HCG can persist over a long period of time and this must be taken into account due to its possible psychological impact. Intracornual methotrexate seems to be more efficacious than intramuscular methotrexate in our series.

Published
2013
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2. Female genital mutilation in Switzerland: a survey among gynaecologists

Author

Patrick Hohlfeld, Sylvie Schulze, and Fabienne Jäger

Subjects
Female circumcision, Male, medicine.medical_specialty, Pediatrics, Prevalence, Health care, medicine, Humans, Curriculum, Family health, Family Health, Genitalia.female, business.industry, Data Collection, General Medicine, Genitalia, Female, Education, Medical, Graduate, Female, Genital Diseases, Female, Gynecology, Self Mutilation, Switzerland, Women's Health, Family medicine, Infibulation, business
Abstract

QUESTION UNDER STUDY: To evaluate the situation of Female Genital Mutilation (FGM) in Switzerland. METHODS: Through a questionnaire, Swiss gynaecologists were asked if they have been confronted to FGMs, if they have been asked to perform infibulations and FGMs. The health representatives (Kantonsarzte/medecins cantonaux) were interviewed on FGM activity at the Canton level. Swiss Medical Schools were asked if FGM was included in the pregraduate curriculum, and an estimated prevalence rate for FGMs in Switzerland was gathered. RESULTS: Among Swiss gynaecologists, 20% reported having been confronted with patients presenting with FGM and among them 40% had been asked about reinfibulation. Gynaecologists are occasionally asked about the possibility of performing FGMs in Switzerland. No activity concerning FGM is reported by health authorities in the Cantons. Teaching about FGM is not included in the curriculum of any of the Swiss medical schools. Approximately 6,700 girls at risk and women who have undergone FGM live in Switzerland. CONCLUSION: The extent to which gynaecologists are confronted to women with FGM may justify further action to try to better understand the situation in Switzerland. Improvement of care by better education of health care providers (guidelines) and prevention of new cases by women's education should also be considered.

Published
2002

3. Prenatal diagnosis of urinary malformations: results in a series of 93 consecutive cases

Author

Blaise J. Meyrat, Maillard-Brignon C, Yvan Vial, Brunisholz Y, Patrick Hohlfeld, and Frey P

Subjects
Adult, Urologic Diseases, medicine.medical_specialty, Urinary system, Concordance, Gestational Age, Autopsy, Prenatal diagnosis, Sensitivity and Specificity, Pregnancy, Prenatal Diagnosis, medicine, Humans, Radionuclide Imaging, Urinary Tract, Retrospective Studies, Fetus, Obstetrics, business.industry, Infant, Newborn, Pregnancy Outcome, Gestational age, General Medicine, medicine.disease, Female, Follow-Up Studies, Prenatal Diagnosis/methods, Radionuclide Imaging/methods, Urinary Tract/abnormalities, Urogenital Abnormalities/diagnosis, Urologic Diseases/congenital, Urologic Diseases/diagnosis, Urogenital Abnormalities, Gestation, business
Abstract

OBJECTIVE: To evaluate the pertinence of prenatal diagnosis in cases of congenital uropathy. STUDY DESIGN: Retrospective evaluation over a period of 6.5 years. METHOD: 93 cases were involved in the comparison of prenatal ultrasonographic diagnosis with neonatal findings, autopsy results, and follow-up data. RESULTS: 33 fetuses had renal parenchymal lesions, 44 had excretory system lesions, and 6 had bladder and/or urethral lesions. Seventy-three pregnancies lead to live births. Eighteen terminations of pregnancy were performed on the parents' request for extremely severe malformations. Two intrauterine deaths were observed, and two infants died in the postnatal period. Prenatal diagnosis was obtained at an average of 27 weeks gestation. Diagnostic concordance was excellent in 82% and partial in 12% of cases with renal parenchymal lesions; the false-positive rate was 6%. For excretory system lesions, concordance was excellent in 87% and partial in 7.4% of cases, with a false-positive rate of 5.6%. Finally, concordance was excellent in 100% of cases of bladder and/or urethral lesions. The overall rate of total concordance was 86%. Partial concordance cases consisted of malformations different from those previously diagnosed, but prenatal diagnosis nevertheless lead to further investigations in the neonatal period and to proper management. The false-positive diagnoses (5.4%) never lead to termination of pregnancy. CONCLUSION: Prenatal diagnosis of congenital uropathy is effective. A third-trimester ultrasonographic examination is necessary to ensure proper neonatal management, considering that the majority of cases are diagnosed at this gestational age.

Published
2001

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