AIMS: To characterize a group of migrant emergency department (ED) patients regarding demographics, access to the ED, mode of referral, use of resources, and short-term outcomes, and to compare them to a group of local ED patients. METHODS: Prospective cohort study with consecutive enrollment of adult patients presenting to the ED of a Swiss tertiary care hospital from October 21st to November 11th, 2013 and February 1st to February 23rd, 2015. In accordance with the International Organization for Migration, we defined migrants as persons who have changed their country of usual residence, irrespective of their legal status. The primary outcome was defined as the number of resources allocated to migrants, as compared to local patients, using uni- and multivariable quasi-Poisson regressions. Acute morbidity, hospitalization, intensive care unit (ICU) admission, and 30-day mortality were assessed as secondary outcomes. RESULTS: Migrant patients were younger, more often male and self-presenters, and of lower acuity. After adjustment for age, gender and acuity, we observed a non-significant difference of 3.6% in the mean number of resources allocated to migrant patients as compared to local patients (adjusted RR 0.964, CI 0.923-1.006). No difference in 30-day mortality (adjusted OR 0.777, CI 0.346-1.559) was observed between the two patient groups, but migrant patients had lower odds of acute morbidity (adjusted OR 0.652, CI 0.560-0.759), hospitalization (adjusted OR 0.666, CI 0.555-0.799), and ICU admission (adjusted OR 0.649, CI 0.456-0.910). CONCLUSIONS: ED access approximation, resource allocation, and mortality were comparable between migrant patients and local patients. Lower admission rates to wards and the ICU may raise concerns but can be explained by lower acute morbidity in migrant patients.
Background/Aim: Reconstruction of diaphyseal tibial sarcomas with extracorporeal irradiated autograft is a rarely applied technique and is analyzed in this study. Patients and Methods: Eight patients with malignant sarcomas received local treatment by means of a wide resection and reimplantation of an extracorporeallyirradiated autograft. The graft was combined with an ipsilateral vascularized fibula when a full-thickness segment of the tibia had to be resected and no cortex could be preserved (n=5). Oncological and functional results were recorded. Results: All patients had clear margins after resection, and with no local recurrence 72 months after treatment. Full weight-bearing was allowed at the time of radiological consolidation of the irradiated grafts (after a median of five months). The functional results were good and excellent in 7 of 8 patients, respectively. Conclusion: Extracorporeal irradiation grafting is a suitable method for the treatment of localised and resectable tibial sarcomas. Diaphyseal sarcomas at the tibia are rather rare and sometimes challenging due to the reduced soft tissue coverage, as well as the poor blood supply (1). Common treatment options include wide resection and reconstruction with intercalary endoprostheses, as well as biological strategies such as distraction osteogenesis, the induced membrane technique, or vascularised/non-vascularised bonegrafts (2). 2015 This article is freely accessible online.
Ein 26-jähriger Patient stellte sich notfallmäßig bei seit 8 Monaten persistierender Schwellung und Schmerzen präaurikulär links in unserem HNO-Ambulatorium vor. Anamnestisch war der Patient bereits 3-malig in einem anderweitigen Spital vorstellig gewesen, wo bei V. a. Sialadenitis der Gl. Parotis jeweils eine antibiotische Therapie mit Co-Amoxicillin etabliert wurde. Trotz analgetischer und antibiotischer Therapie war es jedoch zu keiner Besserung der Beschwerden gekommen. Eine Bildgebung war bis dato nicht erfolgt. Der sonst gesunde Patient verneinte auf Nachfrage eine B-Symptomatik, Hirnnervenausfälle oder Hirndrucksymptomatik.
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