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14.-15.11.2013Congress Centre Kursaal Interlakenwww.imk.ch/greatupdate2013

4. SGIM Great Update

13.-14.11.2014

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TARGIN® together strongtogether strongtogether strong

NALOXONOXYCODON

11/2

012

Indiziert bei mittelstarken bis starken prolongierten Schmerz

en

TARGIN® Ta-bletten retardZ: Wirkstoffe: Oxy-codoni hydrochlori-dum anh. / Naloxoni hy-drochloridum anh.: Tablet-ten retard à 5/2,5; 10/5; 20/10; 40/20 mg. Hilfsstoffe: Lactosum monohydricum, excip. pro compresso obducto. 5/2,5 mg: color.: E133. I: Mittel-starke bis starke prolongierte Schmerzen bzw. bei ungenügender Wirksamkeit nicht-opioider Analgetika. Naloxon dient der Therapie und/oder Prophylaxe einer opioidinduzierten Obstipation. D: Übliche Anfangsdosis für nicht-opioidgewöhnte Patienten im Allgemeinen 10/5 mg alle 12 Stunden. Individuelle, stufenweise Dosisanpassung bis zur Schmerzbefreiung. Maximale Tagesdosierung 80/40 mg. Bei höheren Dosierungen Auftitra-tion mit retardiertem Oxycodon. Alle Wirkstärken sind untereinander austauschbar. Gabe von nicht retardiertem Oxycodon bei Durchbruchschmerzen. Bei Kindern/Jugendlichen unter 18 Jahren nicht empfohlen. Vorsicht bei Leber- und Nierenfunktionsstörungen s. KI/WH/VM. KI: Überempfindlichkeit gegenüber Wirk-/Hilfsstoffe, schwere Atemdepression mit Hypoxie und/oder Hyperkapnie, schwere COPD, Cor pulmonale, akutes schweres Bronchialasthma, paralytischer Ileus, Schwangerschaft und Stillzeit, mittlere bis starke Leberfunktionsstörung. WH/VM: Nicht zur Entzugsbehandlung geeignet. Bei Krebspatienten mit Peritonealkarzinose oder beginnender Darmobstruktion, Atemdepression, älteren oder geschwächten Patienten, paralytischem Ileus, schwerer Beeinträchtigung von Lungen- oder Nierenfunktion, geringer Leberfunktionsstörung, Myxödem, Hypothyreose, Addisonscher

Krankheit (Nebennierenrinden-Insuffizienz), Intoxikations-Psychose, Cholelithiasis, Prostatahypertrophie, Alkoholismus, Delirium tremens, Pankreatitis, Hypotonie, Hypertonie, vorbestehenden Herzkreislauf-erkrankungen, Kopfverletzungen, Epilepsie oder Prädisposition zu Krampfanfällen, Einnahme von MAO-Hemmern, hereditärer Galactose-Intoleranz, Lactase-Mangel oder Glucose-Galactose-Malabsorption, Gabe prä/postoperativ, Beeinträchtigung des Reaktionsvermögens,

p h y s i s c h e r und psychischer

Abhängigkeit bei falscher oder miss-

bräuchlicher Anwen-dung. Retardtabletten dür-

fen nicht zerteilt, zerkaut oder zerrieben werden. IA: Ver-

stärkung des ZNS-dämpfenden Effekts mit zentral dämpfend wir-

kenden Substanzen, Veränderung der Thromboplastinzeit mit Cumarin-Derivaten, Aus-

wirkungen auf Pharmakokinetik, -dynamik, analge-tische Wirkung und Sicherheit mit CYP2D6 und CYP3A4-

Inhibitoren sowie bei genetischen CYP2D6-Polymorphismen. Schwangerschaft/Stillzeit: s. KI. UW: Häufig: Appetitabnahme bis Appetit-

verlust, Unruhe, Kopfschmerz, Schwindelgefühl, Vertigo, Blutdrucksenkung, Abdominal-schmerz, Obstipation, Diarrhö, Mundtrockenheit, Dyspepsie, Erbrechen, Übelkeit, Flatulenz, Erhöhung leberspezifischer Enzyme, Pruritus, Hautreaktionen/Hautausschlag, Hyperhidrosis, Arzneimittelent-zugssyndrom, Hitze- und Kältegefühl, Schüttelfrost, Schwächezustände (Asthenie), Atemdepression, Miosis, Bronchospasmus und Spasmen der glatten Muskulatur, Dämpfung des Hustenreflexes, Stimmungs- und Persönlichkeitsveränderungen, verminderte Aktivität, psychomotorische Hyperak-tivität, Agitiertheit, Schluckauf, Dysurie. Abgabekategorie: A+. Untersteht dem Bundesgesetz über die Betäubungsmittel und die psychotropen Stoffe. Zulassungsinhaberin: Mundipharma Medical Company, Hamilton/Bermuda, Zweigniederlassung Basel, St. Alban-Rheinweg 74, 4052 Basel. www.mundipharma.ch. Stand der Information: Mai 2011. ®: TARGIN ist eine registrierte Marke. Die vollständige Fachinformation ist auf der Homepage von Swiss-medic (www.swissmedic.ch) oder unter www.swissmedicinfo.ch publiziert.

kassen-zulässig

für eine normale D

armfu

nktio

n

für e

ine

starke Analgesie

5

Tagesübersicht | Tableau journalier 2-3Willkommen | Bienvenue 6Allgemeine Hinweise | Reseignements généraux 7-9Partnerfirmen | Entreprises partenaires 10Standplan | Plan des exposants 11

Programmübersicht Donnerstag | Vue du programme jeudi 14.11.2013 12-13

Hauptvorträge | Conférences principales 14

Plenar Session 1-8 15-20Workshops 1-11, Workshop 21 21-29

Programmübersicht Freitag | Vue du programme vendredi 15.11.2013 30-31Hauptvorträge | Conférences principales 32-34Plenar Session 9-16 35-39Workshops 12-23 40-48

Referentenliste | Liste des orateurs 49Saalplan | Vue des salles 50

Inhaltsverzeichnis | Table des matières

TARGIN® together strongtogether strongtogether strong

NALOXONOXYCODON

11/2

012

Indiziert bei mittelstarken bis starken prolongierten Schmerz

en

TARGIN® Ta-bletten retardZ: Wirkstoffe: Oxy-codoni hydrochlori-dum anh. / Naloxoni hy-drochloridum anh.: Tablet-ten retard à 5/2,5; 10/5; 20/10; 40/20 mg. Hilfsstoffe: Lactosum monohydricum, excip. pro compresso obducto. 5/2,5 mg: color.: E133. I: Mittel-starke bis starke prolongierte Schmerzen bzw. bei ungenügender Wirksamkeit nicht-opioider Analgetika. Naloxon dient der Therapie und/oder Prophylaxe einer opioidinduzierten Obstipation. D: Übliche Anfangsdosis für nicht-opioidgewöhnte Patienten im Allgemeinen 10/5 mg alle 12 Stunden. Individuelle, stufenweise Dosisanpassung bis zur Schmerzbefreiung. Maximale Tagesdosierung 80/40 mg. Bei höheren Dosierungen Auftitra-tion mit retardiertem Oxycodon. Alle Wirkstärken sind untereinander austauschbar. Gabe von nicht retardiertem Oxycodon bei Durchbruchschmerzen. Bei Kindern/Jugendlichen unter 18 Jahren nicht empfohlen. Vorsicht bei Leber- und Nierenfunktionsstörungen s. KI/WH/VM. KI: Überempfindlichkeit gegenüber Wirk-/Hilfsstoffe, schwere Atemdepression mit Hypoxie und/oder Hyperkapnie, schwere COPD, Cor pulmonale, akutes schweres Bronchialasthma, paralytischer Ileus, Schwangerschaft und Stillzeit, mittlere bis starke Leberfunktionsstörung. WH/VM: Nicht zur Entzugsbehandlung geeignet. Bei Krebspatienten mit Peritonealkarzinose oder beginnender Darmobstruktion, Atemdepression, älteren oder geschwächten Patienten, paralytischem Ileus, schwerer Beeinträchtigung von Lungen- oder Nierenfunktion, geringer Leberfunktionsstörung, Myxödem, Hypothyreose, Addisonscher

Krankheit (Nebennierenrinden-Insuffizienz), Intoxikations-Psychose, Cholelithiasis, Prostatahypertrophie, Alkoholismus, Delirium tremens, Pankreatitis, Hypotonie, Hypertonie, vorbestehenden Herzkreislauf-erkrankungen, Kopfverletzungen, Epilepsie oder Prädisposition zu Krampfanfällen, Einnahme von MAO-Hemmern, hereditärer Galactose-Intoleranz, Lactase-Mangel oder Glucose-Galactose-Malabsorption, Gabe prä/postoperativ, Beeinträchtigung des Reaktionsvermögens,

p h y s i s c h e r und psychischer

Abhängigkeit bei falscher oder miss-

bräuchlicher Anwen-dung. Retardtabletten dür-

fen nicht zerteilt, zerkaut oder zerrieben werden. IA: Ver-

stärkung des ZNS-dämpfenden Effekts mit zentral dämpfend wir-

kenden Substanzen, Veränderung der Thromboplastinzeit mit Cumarin-Derivaten, Aus-

wirkungen auf Pharmakokinetik, -dynamik, analge-tische Wirkung und Sicherheit mit CYP2D6 und CYP3A4-

Inhibitoren sowie bei genetischen CYP2D6-Polymorphismen. Schwangerschaft/Stillzeit: s. KI. UW: Häufig: Appetitabnahme bis Appetit-

verlust, Unruhe, Kopfschmerz, Schwindelgefühl, Vertigo, Blutdrucksenkung, Abdominal-schmerz, Obstipation, Diarrhö, Mundtrockenheit, Dyspepsie, Erbrechen, Übelkeit, Flatulenz, Erhöhung leberspezifischer Enzyme, Pruritus, Hautreaktionen/Hautausschlag, Hyperhidrosis, Arzneimittelent-zugssyndrom, Hitze- und Kältegefühl, Schüttelfrost, Schwächezustände (Asthenie), Atemdepression, Miosis, Bronchospasmus und Spasmen der glatten Muskulatur, Dämpfung des Hustenreflexes, Stimmungs- und Persönlichkeitsveränderungen, verminderte Aktivität, psychomotorische Hyperak-tivität, Agitiertheit, Schluckauf, Dysurie. Abgabekategorie: A+. Untersteht dem Bundesgesetz über die Betäubungsmittel und die psychotropen Stoffe. Zulassungsinhaberin: Mundipharma Medical Company, Hamilton/Bermuda, Zweigniederlassung Basel, St. Alban-Rheinweg 74, 4052 Basel. www.mundipharma.ch. Stand der Information: Mai 2011. ®: TARGIN ist eine registrierte Marke. Die vollständige Fachinformation ist auf der Homepage von Swiss-medic (www.swissmedic.ch) oder unter www.swissmedicinfo.ch publiziert.

kassen-zulässig

für eine normale D

armfu

nktio

n

für e

ine

starke Analgesie

Donn

erst

ag |

Jeu

diFr

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Vend

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6

Liebe Kolleginnen, liebe Kollegen

Wir freuen uns ausserordentlich, Sie hiermit zur dritten Durchführung des SGIM Great Updates einzuladen. Diese Fortbildungsveranstaltung der Schweizerischen Gesellschaft für Allgemeine Innere Medizin (SGIM) findet vom 14. bis 15. November 2013 im Congress Centre Kursaal Interlaken statt und ist auf die Grundversorger in der Praxis ausgerichtet.

Das SGIM Great Update ist eine etablierte Fortbildung für Hausärzte mit äusserst zufriedenen Teilnehmenden in den vergangenen Jahren und soll den interaktiven Austausch unter den Teilnehmern fördern. Hierzu wird ein grosser Teil des Great Update aus Workshops bestehen. Das Hauptziel ist die Fortbildung von rund 500 Grundversorgern auf dem Gebiet der Allgemeinen Inneren Medizin und ausgewählten Subdisziplinen.

Das wissenschaftliche Komitee scheut keine Mühen, Ihnen auch 2013 ein interessantes Programm anzubieten. Nebst dem wissenschaftlichen Teil runden eine attraktive Industrieausstellung sowie Satellitensymposien das Programm ab.

Wir freuen uns sehr, Sie im Rahmen des 3. SGIM Great Updates in Interlaken begrüssen zu dürfen!

Prof. Dr. med. Jörg Daniel Leuppi Prof. Dr. med. Jonas Rutishauser Tagungs-Copräsident Tagungs-Copräsident

Chères et chers collègues,

En 2013, la Société Suisse de Médecine Interne Générale (SSMI) organisera pour la troisième fois une manifestation de formation continue qui s’intitulera Great Update de la SSMI. Le congrès se tiendra le 14 au 15 novembre 2013 au Congress Centre Kursaal à Interlaken.

Avec ce concept établi, le Great Update de la SSMI vise à promouvoir une formation continue axée sur la pratique ainsi que l’échange interactif entre les participants. Un volet important du Great Update se présentera sous forme d’ateliers.

Nous sommes certains que cette plateforme vous inspirera et vous incitera à prendre part aux présentations de divers thèmes cliniques ou encore à participer à l’un des ateliers pratiques.

Nous serions ravis de vous compter parmi nous à Interlaken lors du troisième Great Update de la SSMI!

Avec nos cordiales salutations,

Pr Dr méd. Jörg Daniel Leuppi Pr Dr méd. Jonas Rutishauser Co-président du congrès Co-président du congrès

Willkommen | Bienvenue

7

14.–15.11.2013

Congress Centre Kursaal InterlakenStrandbadstrasse 44CH-3800 Interlaken

Tagungs-Copräsidenten | Co-présidents du congrèsProf. Dr. med. Jörg Daniel Leuppi, LiestalProf. Dr. med. Jonas Rutishauser, Bruderholz

Dr. med. Romeo Providoli, SierreDr. med. Sven Streit, BernDr. med. Susanna Stöhr, Luzern IMK Institut für Medizin und KommunikationMünsterberg 1, CH-4001 BaselTel: +41 61 271 35 51, Fax: +41 61 271 33 38congress@imk.ch | www.imk.ch

Schweizerische Gesellschaft für Allgemeine Innere Medizin (SGIM): 11Société Suisse de Médecine Interne Générale (SSMI) : 11

Teilnehmende der SGIM Jahrestagung 2013 erhalten nach Vorweisen derBestätigung CHF 50.- Reduktion am SGIM Great Update 2013.Participants à I’Assemblée Annuelle de la SSMI 2013 reçoivent une réductionde CHF 50.- pour le Great Update 2013 après la présentation de leur confirmation.

Allgemeine Hinweise | Reseignements généraux

Datum | Date

Ort | Lieu

Wissenschaftliches KomiteeComité scientifique

Administratives SekretariatSecrétariat administratif

Credits

Teilnahmegebühren Frais d’enregistrement

Alle Preise verstehen sich in Schweizer Franken | Touts les prix sont en Francs suisses (CHF)

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Teilnahmegebühren in CHFFrais d’inscription en CHF

Early bird

(until 10.10.2013)

Regular

(11.10.- 12.11.2013)

Onsite

Tage | Jours 1 2 1 2 1 2Mitglied SGIM, SGAM | Membres SSMI, SSMG 130 170 180 220 230 270

Nicht-Mitglied | Non membres 180 220 230 270 280 320

Assistenzärzte, StudentenMéd. assistants, Etudiants 90 110 120 160 170 210

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European and Swiss Congress of Internal Medicine 201414 -16 May, 2014Geneva, Switzerland

the 13th European Congress of Internal Medicine of the European Foundation of Internal Medicine (EFIM) and the 82nd Annual Meeting of the Swiss Society of General Internal Medicine (SGIM)

www.escim2014.org

Together

A joint venture of

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Festabend

Der Festabend findet am Donnerstag, 14. November 2013 im Restaurant OX in Interlaken statt.Der Apéro beginnt um 19:00 Uhr.Kosten: Ärzte CHF 80.- | Assistenzärzte CHF 50.-

Hochwertige Fleischgerichte, zubereitet in der Schauküche am Molteni-Rotissoire. Das ist das Markenzeichen des neuen OX Restaurant & Grill in Interlaken. Seit Mai 2012 setzen die jungen Köche Massstäbe in der Zubereitung von hochwertigem Fleisch, frischem Fisch und edlen Krustentieren. Die verwendeten Produkte stammen, wo immer möglich, aus der Region. Für die Speisekarte verantwortlich ist der Sternekoch Richard Stöckli, als Küchenchef amtet Roman Meyer - ein ehemaliger Sous-Chef im Gourmettempel ’Blaue Ente’ in Zürich.

Dîner de fête

Le dîner de fête aura lieu jeudi 14 novembre 2013, 19:00 h au restaurant OX à Interlaken.Frais : Médecins CHF 80.- | Méd. assistants CHF 50.-

Des plats de viande de haute qualité, une cuisine de démonstration où les experts en arts culinaires de la Molteni-Rotissoire montrent leurs talents. C’est la marque de qualité du nouveau OX Restaurant & Grill à Interlaken. Les jeunes cuisiniers ont développé un nouveau standard qualitée pour la préparation de la viande, du poisson frais et des crustacées. Tous les produits proviennent - dans la mesure du possible - de la région. Le chef étoilé Richard Stöckli est responsable de la création du menu, monsieur Roman Meyer - ancien Sous Chef dans le temple gourmet «Blaue Ente» à Zurich - est le nouveau chef de cuisine.

Allgemeine Hinweise | Reseignements généraux

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PartnerfirmenEntreprises partenaires

Partner

Wir danken folgenden Partnerfirmen für ihre grosszügige Unterstützung:Nous remercions les Entreprises partenaires suivants de leurs généreuses donations :

Allgemeine Hinweise | Reseignements généraux

Aussteller | Exposants

Alphabetisch | par ordre alphabétiqueNr. Firma | Firme

25 A. Menarini AG11 Aerztekasse Genossenschaft15 Almirall AG22 baumann medical ag 2 Bayer (Schweiz) AG26 Boehringer Ingelheim (Schweiz) GmbH10 Bristol-Myers Squibb SA 8 ConvaTec (Switzerland) GmbH 6 GlaxoSmithKline AG28 Janssen-Cilag AG18 labor team w ag17 Medisupport SA24 Mepha Pharma AG21 Merck (Schweiz) AG14 Mundipharma Medical Company 1 Nestlé HealthScience 3 Novartis Pharma Schweiz AG16 Novo Nordisk Pharma AG23 Pfizer AG19 Pro Farma AG 9 Proxima Medical Systems AG 7 Schülke & Mayr AG 5 Schwabe Pharma AG29 Servier (Suisse) S.A.20 SGIM27 Streuli Pharma AG13 Sysmex Digitana AG 4 Vifor Pharma AG12 Viollier AG

Nach Standnummer | par ordre de standNr. Firma | Firme

1 Nestlé HealthScience 2 Bayer (Schweiz) AG 3 Novartis Pharma Schweiz AG 4 Vifor Pharma AG 5 Schwabe Pharma AG 6 GlaxoSmithKline AG 7 Schülke & Mayr AG 8 ConvaTec (Switzerland) GmbH 9 Proxima Medical Systems AG10 Bristol-Myers Squibb SA11 Aerztekasse Genossenschaft12 Viollier AG13 Sysmex Digitana AG14 Mundipharma Medical Company15 Almirall AG16 Novo Nordisk Pharma AG17 Medisupport SA18 labor team w ag19 Pro Farma AG20 SGIM21 Merck (Schweiz) AG22 baumann medical ag23 Pfizer AG24 Mepha Pharma AG25 A. Menarini AG26 Boehringer Ingelheim (Schweiz) GmbH27 Streuli Pharma AG28 Janssen-Cilag AG29 Servier (Suisse) S.A.

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Standplan | Plan des exposants

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Donnerstag | Jeudi 14.11.2013

Programm | Programme D F

09:00-09:45

Willkommenskaffee & Registrierung | Café de bienvenue & Inscription

09:45-10:00

Begrüssung | Bienvenue Jörg D. Leuppi, Liestal

10:00-11:00

Hauptvorträge | Chair: Jörg D. Leuppi, LiestalTheatersaal

10:00-10:30

Management VorhofflimmernJens Eckstein, Basel x

10:30-11:00 Update: Hypertonie-BehandlungenFrank Ruschitzka, Zürich x

11:00-11:30 Kaffeepause | Pause café

11:30-12:30

Industrieforum | Colloque de l‘industrie | Theatersaal Novo Nordisk Pharma AG

Workshop 1 xNeue Therapieoptionen in der Behandlung des Typ 2 DiabetesRoger Lehmann, Zürich

12:30-13:30 Lunch | Déjeuner

13:30-14:00

Plenar Session 1 | Chair: Esther Bächli, UsterTheatersaal

Workshops2-6

Hot topicsJonas Rutishauser, Bruderholz x

13:30-14:00

Plenar Session 2 | Chair: Joel Cuénod, BaselBallsaalInsuffisance cardiaqueJean-Michel Gaspoz, Genève x

14:00-14:30

Plenar Session 3 | Chair: Esther Bächli, UsterTheatersaalPräoperative Abklärungen in der PraxisKarl Hampl, Biel | Bienne x

14:00-14:30

Plenar Session 4 | Chair: Joel Cuénod, BaselBallsaalHépatite C: ce que doit connaître le praticien Daniel Genné, La Chaux-de-Fonds x

14:30-15:00 Kaffeepause | Pause café

15:00-16:00 Workshops 2-11

16:00-16:30 Kaffeepause | Pause café

16:30-17:00

Plenar Session 5 | Chair: Sven Streit, BernTheatersaal Workshops

7-11BurnoutTorsten Berghändler, Herisau x

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Donnerstag | Jeudi 14.11.2013

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Workshops 1-11 D F

1 Neurostatus Urs Schwarz, Zürich x

2 Ultraschall in der Praxis Marco Negri, Frutigen x

3 Ultrason dans le cabinet Hans-Jürg Bopp, Gland x x

4 Cas pratiques de diabétologie Marc Egli, Lausanne x

5 Praktische Neurologie: Focus HWS Alfred E. Müller, Zürich x

6 Wundversorgung Andreas Huber, Zürich xMartin Haug, Basel

7 Urinsediment Felix Burkhalter, Basel x

8 La tuberculose en Suisse: quoi de neuf? Die Tuberkulose in der Schweiz: etwas

Neues?Jean-Pierre Zellweger, Fribourg x x

9 Spirometrie Salome Schafroth, Liestal x

10 Quels vaccins pour quels adultes? Alessandro Diana, Genève x

11 Das schwierige Arbeitsunfähigkeits-Zeugnis Alexander Nydegger, Zürich x

Programm | Programme D F

16:30-17:00

Plenar Session 6 | Chair: Jonas Rutishauser, Bruderholz | Ballsaal

Workshops 7-11

Kopfschmerzen sind auch geisteswissenschaftlichzu erklärenMark Emmenegger, Agno

x

17:00-17:30

Plenar Session 7 | Chair: Sven Streit, BernTheatersaalZytochrom-vermittelte Wechselwirkungen und Zytochrom-Genetik in der Hausarztpraxis Walter Häfeli, Heidelberg; D

x

17:00-17:30

Plenar Session 8 | Chair: Jonas Rutishauser, Bruderholz | BallsaalDie Urininkontinenz der FrauJörg Humburg, Bruderholz x

ab | dès 19:00

Festabend im Restaurant OX in Interlaken Dîner de fête au restaurant OX à Interlaken

in deutscher Sprache en françaisD F

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Hauptvortrag | Conférence principale - Donnerstag | Jeudi 14.11.2013

Management VorhofflimmernJens Eckstein, Basel 10:00-10:30 Uhr, Theatersaal

Management VorhofflimmernClincal and basic research on atrial fibrillation results in approximately 4000 scientific papers per year. The continuously increasing information should help us to better understand, manage and eventually cure the disease. Progress is so fast, that by the time the 2010 ESC guidelines were available there was already the need to work on a revision (2012), mainly because of major changes in the field of oral anticoagulation (better validation of the CHA2DS2-VASc Score and availability of the novel oral anticoagulants), the need for adjusting the recommendations for antiarrhythmic drug therapy (Dronedarone) and new results from pulmonary vein isolation trials.The only way to diagnose AF still is the documentation with an ECG. There are increasing efforts to develop better and more sensitive techniques but so far the available choices range from standard resting ECG to implantable loop recorders. Once the diagnosis is confirmed the first thought should be focused on the indication for anticoagulation. With the use of the CHA2DS2-VASc Score and the HAS-BLED Score this decision can be made reasonably fast. Surprisingly enough present real world trials like the GARFIELD registry demonstrate that still about 1/3 of the patients on anticoagulation don’t have a proper indication and 1/3 of patients with a significant stroke risk are not being anticoagulated. Guideline recommendations are balanced for VKA and NOACs, although recent data demonstrate an overall superiority of NOACs. Aspirine is not recommended for standard use any more.Once this has been taken care of, the choice between rhythm- and rate control has to be addressed. Most important here: To treat the patient, not the disease! We should check for risk factors and triggers of AF and decide individually together with our patient which strategy to pursue. Factors favouring rate control are: persisting AF, little or no symptoms and old age. Factors favouring rhythm control are: paroxysmal AF, presence of symptoms, young age and the presence of heart failure.If rate control is chosen, beta blockers and non dihydropyridine Ca-Antagonists should be considered as first choice, followed by Digitalis, Amiodarone or AV-Node ablation. Please note that rate control aims at a resting heart rate below 110/min and not 80/min!If rhythm control is chosen all available antiarrhythmic drugs should be considered accordingly to the guidelines. In general it is recommended to give antiarrhythmic drug therapy a try before moving to catheter ablation. If catheter ablation is considered it should be performed in experienced centres.In either case guidelines do NOT recommend to stop oral anticoagulation even if rhythm control is achieved although there is recent data suggesting that patients who underwent AF ablation reduce their stroke risk to the level of patients without a history of AF.

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Plenar Session 2 - Donnerstag | Jeudi 14.11.2013

Insuffisance cardiaqueJean-Michel Gaspoz, Genève13:30-14:00 Uhr, Ballsaal

Heart failure is the only cardiovascular disease the prevalence of which is increasing: 14.7% of men and 12.8% of women aged >80 years in the USA. In Switzerland, 20’000 new cases are diagnosed each year. Its prognosis remains grim with a 50 % mortality within 5 years.

Nowadays, one considers 3 phases in heart failure: - acute decompensation, responsible for a hospitalization; - a post-hospitalization phase (60-90 days after hospital discharge); - chronic heart failure. Rehospitalization rates within 60-90 days of hospital discharge reach 30% and mortality 15%, numbers which have remained unchanged during the last 10 years. However, a majority of these patients were stable at hospital discharge. These findings call for a closer partnership between hospital and community physicians during what is now considered as a critical period.

Concerning the treatment of systolic heart failure, one still distinguish 2 types of medications: those which relieve symptoms and those which save lives.

Digoxin and diuretics belong to the first category. Concerning diuretics, the superiority of torasemide over furosemide is now established. The role of digoxin remains debated: if it reduces rehospitalization rates, digoxin may increase mortality in women. This is why ivabradin is now recommended before digoxin in patients with a normal sinus rythm, a heart rate ≥ 70/min, and who remain symptomatic.

ACE inhibitors, Angiotensin Receptor Blockers, Beta-Blockers and Aldosterone Receptor Antagonists belong to the second category. Concerning the latter molecules, eplerenone is now considered as an effective alternative to spironolactone in patients with side effects on that drug; these 2 molecules are now recommended earlier in the treatment algorithm (Class II patients). A last clarification: resynchronization pacemakers are now proposed only in patients with a QRS≥120 ms.

For patients in atrial fibrillation, Beta Blockers are now listed as first line treatment, before digoxin.

In diastolic heart failure, no molecule has yet proven to prolong survival ; treatments remain symptomatic. The new recommandations of the European Society of Cardiology and of the Swiss Society of Cardiology, summarized above, underline the importance of non-pharmacological approaches (diet and exercice) and of patient impowerment.

1. ESC Guidelines for the diagnosis and treatment of acute and chronic Heart Failure 2012. European Heart Journal doi: 10.1093/eurheartj/ehs104.

2. Recommandations 2013 du groupe de travail suisse pour l’insuffisance cardiaque.

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Plenar Session 4 - Donnerstag | Jeudi 14.11.2013

Hépatite C: ce que doit connaître le praticienDaniel Genné, La Chaux-de-Fonds14:00-14:30 Uhr, Ballsaal

What you should know about Hepatitis C

Since its discovery in 1989, the hepatitis C virus has passed many phases, from the description of the viral life cycle and the determination of the 6 main genotypes, to its treatment, namely to the possibility of curing almost 60% -70% of all infected patients in 2013.In Switzerland we consider that about 1.5% of the population are chronically infected, which represents 80‘000 people who should be followed. Only about half of them are aware of being infected and less than 10% have been successfully treated. GPs play a major role in screening asymptomatic infected patients. The population to test in priority includes the following: all former drug users, recipients of blood products before 1992, men having sex with men, persons having a tatoo or a piercing done, children born to HCV-positive mothers, those with persistently elevated transaminases and healthcare workers. The USA guidelines advise to test all those born between 1945 and 1965. This has not been recommended by the swiss medical authorities. Once detected, patients should undergo a work-up which consist of determining the genotype (important for choosing the best treatment), the viral load, the hepatic transaminase levels, a hepatic ultrasound and a search for a co-infection like HIV and HBV. Staging of the disease is an important step before deciding about treating the patient. Liver biopsy is the gold standard. New tools are available, like transient elastography (Fibroscan®) or specialized serum tests (Fibrotest®) which give interesting results mainly for advanced diseases (F4 = cirrhosis) or for the absence of fibrosis (F0). A patient with a F0-F1 stage can wait for treatment, whereas stage ≥ F2 needs to be treated.Enormous progress has been made in the treatment against hepatitis C, going from a monotherapy by interferon in 1990 with a 6% success (sustained viral load which means no virus detected 6 month after the end of the treatment, which also means recovery of the infection) to a triple therapy of Peginterferon + Ribavirine + antiprotease (Boceprevir or Telaprevir) since 2011 with a success of close to 70% for the most resistant genotype (G1). Despite this success, the treatment remains very difficult for almost all patients because of the important side effects of this triple therapy as well as the failure rate which remains too high. We urgently need better, shorter and more tolerable therapies effective against all genotypes. More than 200 studies with approximately 30 new substances are ongoing. Next generation antiproteases (NS3-4A), antipolymerase (NS5B) and NS5a inhibitors are the main new drug families called „Direct acting antiviral agents (DAAs)“. They will arrive on the market soon (begining with Sofusbuvir, Daclatasvir, Faldeprevir ans Simeprevir expected 2014-2015). These treatments combined together will be easy to take (on pill each a day), will be given without interferon for short periods of time like 3 months only, according to the genotype, will have few side effects and an expected success of > 90%.As so many new drugs and combinations will be available, it‘s almost impossible for all doctors to be able to manage these treatments, so patients should best be referred to a hepatologist or an infectious diseases specialist. But GPs plays an important role by screening there patients, by doing the work-up and by following the patients after the treatment. This is the best way to reduce the number of cases of cirrhosis and hepatic carcinomas for which the peak of incidence is still awaited in about ten years.

Less than 25 years after its discovery, it will be possible to treat and cure almost all HCV infected patients, unfortunately to a very high price. The next question will be who should really receive those expensive drugs?

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Plenar Session 5 - Donnerstag | Jeudi 14.11.2013

BurnoutTorsten Berghändler, Herisau16:30-17:00 Uhr, Theatersaal

Burnout-SyndromDas Burnout-Syndrom (BOS) wird zu einem der häufigsten psychischen Störungsbilder bzw. Risiken in der Arbeitswelt. BOS wird zunehmend, auch offiziell, als Krankheitsbild anerkannt. Psychopathologisch, testpsychologisch wie auch neurophysiologisch kann das BOS zunehmend besser von Depression und anderen Stress-Erkrankungen unterschieden werden. Ärzte sind mit der Diagnose und dem Management von BOS nicht nur bei ihren Patienten gefordert, sondern stellen selber, in der Klinik wie der niedergelassenen Praxis, eine relevante Risikogruppe dar.Im Vortrag werden Diagnostik und Differentialdiagnostik des Burnout-Syndroms, Behandlung und Rückfallprophylaxe dargestellt. Zudem wird ein Fokus gelegt auf die eigene Burnout-Prophylaxe der ärztlich Tätigen.

The so called `burnout-syndrome`(BOS) seems to be becoming one of the most common stress-spectrum disorders and risk faktors in work environments. Also officially, BOS is being more and more accepted as a genuine disease. Increasingly BOS can be differentiated from depression and other stress related disorders by means of psychopathology, psychological testing and neurophysiological parameters. Not only are physicians challenged to diagnose and manage BOS in their patients - but they themselves are a relevant group at risk, whether working clinically or in their own surgery.

This lecture will give an overview over the diagnosis and differential diagnosis of the burnout syndrome (BOS), of treatment and prevention of relapse. Furthermore the physician´s own prophylaxis of BOS will be emphasized.

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Plenar Session 6 - Donnerstag | Jeudi 14.11.2013

Kopfschmerzen sind auch geisteswissenschaftlich zu erklärenMark Emmenegger, Agno16:30-17:00 Uhr, Ballsaal

Headache can also be explained by humane sciencesPatients perceive headaches subjectively in the inner perspective and the physicians observe headaches from an external standpoint. That’s why it is indispensable that we look for a harmony between biomedicine and humane sciences.Patients with headache are in a condition of anxiety, alarm and fear the worst, to lose control, to remain affected. Their ability to communicate is impaired like Virginia Woolf wrote: “Let a sufferer try to describe a pain in his head to a doctor and the language at once runs dry”.Doctors have to learn to interpret all the verbal and non verbal signs of headache and try to understand their meaning and importance.Humans can express headaches and suffering according to needs and possibilities; describe it through words (telling a story, literature), through gestures, behaviour, performing arts, symbols or through music and rhythm. If headache becomes intolerable what remains is yelling, crying and falling quiet.We all are exposed to the polarity of pain and fortune or like Jeremy Bentham said: „Nature has placed mankind under the governance of two sovereign masters, pain and pleasure”.If headache or pain has a mean to an end (Mittel zum Zweck) it becomes comprehensible such as by salvation (religion), by ascesis (overcoming), fair-minded punishment (moral), by ultimate experience (extreme sport) or by sado-masochism.The physical science approach to headaches describes real findings, MRI-structures, electrical activities, metabolic results by PET and fMRI and gives a description of pharmacological and haemodynamic consequences of the treatment. From a humanistic standpoint we have to criticize that this approach is incomplete by neglecting and ignoring the patient’s individual, social, religious, emotional, philosophical and ethical aspects. That’s why I favour a “Medical Humanity” as an essential component in the clinical activity of all physicians.Are there doctors around with Medical Humanity? Yes and how! The general practitioner, the GP, der Hausarzt, die Hausärztin, il medico di famiglia, le médecin de famille.This group of doctors are guided by an ethics of care.

The good physician treats the disease;the great physician treats the patient, who has the disease. (Sir William Osler)

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Plenar Session 7 - Donnerstag | Jeudi 14.11.2013

Zytochrom-vermittelte Wechselwirkungen und Zytochrom-Genetik in der HausarztpraxisWalter Häfeli, Heidelberg; D17:00-17:30 Uhr, Theatersaal

Cytochrome-mediated interactions and cytochrome genetics in general practiceAlterations in liberation, absorption, distribution, metabolism, and excretion may all affect the pharmacokinetics of a drug, but most relevant are changes affecting the clearance because they can immediately translate into changes of overall exposure. Above all other structures, cytochrome P450 (CYP) enzymes determine the clearance of drugs. Of the more than 50 CYP currently known, the most relevant enzymes involved in drug metabolism are, in descending order, CYP3A4, CYP2D6, CYP2C9, CYP2C19, and CYP1A2. Interindividual variability of the activities of these isozymes is large and also depends on co-medication. If combined with inhibitors or inducers of individual enzymes (so-called perpetrator drugs) exposure of substrates (victim drugs) will increase or decrease as will its pharmacological effects. Therefore, such drug-drug interactions can be used to enhance the effectiveness of drugs, but they are also a significant cause of adverse drug reactions or treatment failure. Moreover, CYP activities are also modulated by genetic polymorphisms, i.e. genetic variants with a prevalence ≥1% in a general population. Indeed, for CYP2D6, CYP2C9, and CYP2C19 a number of genotypes with deficient activity have been reported leading to loss of enzyme function in 3-8% of the Caucasians (so called poor metabolizers), whose drug clearance is low compared to the more frequent wild-type phenotype (extensive metabolizers). Whether such differences are clinically relevant depends on the nature of the substrates; if the parent compound is active and a narrow therapeutic index drug, significant toxicity may occur at regular doses. In contrast, if the drug is inactive (prodrug) requiring activation by this metabolic step, nonresponse may result in poor metabolizers (as discussed for clopidogrel in CYP2C19 poor metabolizers and for tamoxifen and tramadol in CYP2D6 poor metabolizers). For CYP2C19 and CYP2D6 also gene duplication or multiplication is known (ultrarapid metabolizers) leading to accelerated clearance, lower exposure with parent compound, and sometimes less effectiveness. There is still considerable debate about the significance of CYP polymorphisms in clinical practice and genotyping is currently not generally recommended because often other ways of individualization are available (e.g. titration). Drugs, whose clinical endpoints have been associated with serious adverse outcomes due to CYP polymorphisms and for which genotyping might evolve as a useful strategy to maximize effects, are clopidogrel and tamoxifen, but the role of the respective genotypes is not fully elucidated and, even though data of rather large clinical trials have been analyzed, the results are still contradictory. Finally it should be recognized that co-administration of a perpetrator drug may inhibit a fully active enzyme thus producing a functional poor metabolizer status within short periods of time. Therefore the genotype will only predict baseline activities and the propensity for interactions and only when co-medication is known, actual enzyme activity, clearance, and thus exposure can be estimated.

Suggested reading:Hafner V, Grün B, Markert C, Czock D, Mikus G, Haefeli WE. [Drug interactions]. Internist (Berl) 2010;51:359-69; quiz 370.

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Plenar Session 8 - Donnerstag | Jeudi 14.11.2013

UrininkontinenzJörg Humburg, Bruderholz17:00-17:30 Uhr, Ballsaal

Female Urinary IncontinenceUrinary incontinence (UI) is a common condition that may affect women of all ages, with a wide range of severity and nature. Although rarely life-threatening, UI may seriously influence the physical, psychological and social wellbeing of affected individuals. The impact on the families and carers of women with UI may be profound, and the resource implications for the health service considerable. Approximately 38% of woman experience urinary incontinence.UI is defined by the International Continence Society as ‚the complaint of any involuntary leakage of urine‘. UI may occur as a result of a number of abnormalities of function of the lower urinary tract or as a result of other illnesses, which tend to cause leakage in different situations. There are several different types of urinary incontinence. The two main types are Stress and Urge Urinary Incontinence, others are Overflow Incontinence, Neurogenic Incontinence, Functional Incontinence and Incontinence due to Fistulas. I will focus on the two main types.

Stress UI is involuntary urine leakage on effort or exertion or on sneezing or coughing.

Urge UI is involuntary urine leakage accompanied or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to defer).

Mixed UI is involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing.

A new and important term used is the Overactive bladder syndrome (OAB) is defined as urgency that occurs with or without urge UI and usually with frequency and nocturia. OAB that occurs with urge UI is known as ‚OAB wet‘. OAB that occurs without urge UI is known as ‚OAB dry‘. Stress Urinary Incontinence (SUI) is the result of weak urethral muscle and support. Urge Urinary Incontinence (UUI) is the result of an over active bladder muscle. Diagnose is based on history and physical examination, measuring postvoidal residual volume to exclude Overflow Incontinence and urine screening to rule out urinary tract infection. A vaginal exam may be included. In case of a complicated urinary incontinence or failure of the firstline therapy, the patient should be referred to a specialist for further investigation for example with urethrocystoscopy or urodynamics. Therapy consists of behavioral modification, bladder training, pelvic floor physiotherapy with electrical stimulation and biofeedback, medications with antimuscarinics, vaginal pessaries, surgery (typically a synthetic mesh tape is placed under the urethra) transurethral bulking agent injections, Botox injections in the Detrusormuscle.

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Workshop 3 - Donnerstag | Jeudi 14.11.2013

Ultrason dans le cabinetHans-Jürg Bopp, Gland 13:30-16:00 Uhr, Kongresssaal 2

Diagnostic ultrasound workshop

The diagnostic ultrasound has known a large application field which covers most medical specialties. Actually the ultrasound machines are able to produce clear images with a very high resolution of fine anatomical structures. Principally we can say that many of these images are easy to produce and do not need an extraordinary level of skill. The FAST (Focused Assessment with Sonography in Trauma) proceeding is a classic example of a most important diagnostic contribution to a life threatening emergency situation. But the traditional view that ultrasound can only be used by radiologists and some other specialists after a very long period of training is still largely dominant in many medical circles. The Swiss Society of Ultrasound in Medecine (SGUM) defines a clear training path to achieve certification in being able to practice the diagnostic ultrasound.

In completing this workshop participants will be able to demonstrate the ability to produce clear images of selected parts of the anatomy and its organs. They will see how user friendly the probes and the machines are for constructing images of the inner parts of the human body. The workshop allows every participant to handle the probe to produced images of some easily recognizable anatomic structures, like for example the intact cortical wall of the ribs, the presence or not of stones in the gallbladder, the size of the kidneys, the diameter of the abdominal aorta, the presence or not of liquid in the costophrenic sinus and many other situations.

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Workshop 4.1 & 4.2 - Donnerstag | Jeudi 14.11.2013

Cas pratiques de diabétologieMarc Egli, Lausanne13:30-14:30 Uhr, 15:00-16:00 Uhr, Brünig 3

Management of?

Diabetes care has undergone a profound evolution over the past two decades. Technical and pharmacological advances have made efficient and safe control of hyperglycemia and associated cardiovascular risk factors an achievable goal. Scientific evidence of the impact of control of these risk factors on morbidity and mortality has been provided, while leaving room for ongoing questions and some controversies. For the clinician, therapeutic options have greatly expanded over the last few years, making it a challenge to keep up with the evolution of associated knowledge. Furthermore, no category among the currently available antidiabetic medications can claim a general superiority over the others in the balance between advantages and disadvantages in their use. Efficacy of one drug class can be subject to important interindividual variability, which makes individual therapeutic responses difficult to predict. This means that therapeutic decisions have to be made on the basis of an evaluation process starting with a reasonably feasible and safe initial choice, which needs to be validated or readjusted according to the observed response. The current clinical guidelines have also acknowledged this need for individual tailoring for the therapeutic targets. Finally patient involvement is always a major determinant of therapeutic efficacy in this chronic self-managed condition. The many interferences with lifestyle factors in diabetes require development of decision making capabilities by the patient, which can’t be reduced to compliance with medical prescriptions. Combined with the burden of chronicity, this adds to the challenge for the healthcare professionals’ skills in the fields of patient education and psychosocial support. This workshop based on various clinical cases will review frequent issues and strategies to deal with them.

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Workshop 5.1 & 5.2 - Donnerstag | Jeudi 14.11.2013

Praktische Neurologie: Focus HWSAlfred E. Müller, Zürich13:30-14:30 Uhr, 15:00-16:00 Uhr, Club Casino

Practical NeurologyHandout 2013

Focus cervical spine

In the first part of the workshop there is a theoretical overview. In the second part there is a presentation of everyday and special cases for cervical spine and gait disorders

Neck pain from degenerativ arthritis of the neck is the epidemic proportion 60% to 80% of the elderly population. The pain is gra-dual in onset and initially intermittent and then often becomes constant.Patients mostly suffer from neck pain that can be associated with occipital headache and interscapular pain. The pain and/or sen-sory abnormalities can radiate into the arms in segmental distri-bution (root), peripheral nerve pattern, diffuse or like (poly)neu-ropathies. At persistent neck pain with radiation to the arms and possibly against the legs search gait disturbances.

A cervical spine syndrome can cause very severe pains

Herausgeber: Neurologie Schulthess Klinik, Autor: Alfred E. Müller-Sturm, Gestaltung: CoLeTe

For general understanding oft the cases, we also briefly strip prin-cipals of electophysiological study:Investigations, Electrophysiology

• Electroneurography (Nerve conduction studies) • Electromyography (EMG)• Motor Evoced Potentials (MEP)• Somatosensory Evoked Potentials (SSEP)

Also applies to the electrophysiology Relationship between symptoms / signs and investigations

Relationship between symptoms / signs and investigations,

this is the goal of working up

Back pain is extremely common. It is to distinguish between acute and chronic cervical spine syndrome.Acute cases are often caused by injuries or overstress, the chro-nic cervical spine syndrome can have diverse reasons. It is to look for a tumor or an infection in the spinal area in general. However, the most common causes are of degenerative nature, such as: - dysfunction of the ligaments, - disc transformations, - vertebral joint disorders and additional bone growth on the cervical spine.Not any obvious pathology has to be the cause of symptoms. So we must find the pain generator with our examination tools to get relationships between symptoms, signs and investigations.

Pathology and pain generators

Work up

Approach to the patients with neck problems and gait disorders

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Workshop 6 - Donnerstag | Jeudi 14.11.2013Workshop 21 - Freitag | Vendredi, 15.11.2013

Wundversorgung | Sature des plaiesAndreas Huber, ZürichDonnerstag | Jeudi 14.11.2013, 13:30-16:00 Uhr, Kongresssaal 3Freitag | Vendredi, 15.11.2013, 14:45-17:15 Uhr, Kongresssaal 3

Suture of wounds

Almost all wounds can be closed by various suture techniques (interrupted, running, intracutaneous) on the first place, included severe and contaminated ones, appropriate debridement provided. This applies also to wounds older than six hours, which can be transformed into fresh ones by a correct debridement. I is mandatory that all damaged and necrotic tissue is resected inspite of he risk that the closure of the clean but larger wound can be performed only by a special plastic reconstructive procedure. Avulsed skin flaps must be freed from subcutaneous fat and be replanted like a free skin graft. Special caution is indicated in case the injury is located in the facial or other difficult regions as well in situations where the skin is extremely thin and fragile like in the elderly or after systemic treatment with steroids. In any doubt, the patient should be transferred to a specialized surgical unit. This advice should be kept in mind also when performing biopsies of tumours that are thought to be malignant.

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Workshop 7.1 & 7.2 - Donnerstag | Jeudi 14.11.2013

UrinsedimentFelix Burkhalter, Basel15:00-16:00 Uhr, 16:30-17:30 Uhr, Kongresssaal 4

Urinary sediment examination

The major noninvasive diagnostic tool in evaluation renal diseases available to the clinician is the urinalysis, so a complete urinalysis should be performed in all patients with renal disease. Before performing an urinary sediment examination, screening test with dipstick may be useful.

Methode:The specimen should examined within 60 minutes of avoiding. 10 ml of midstream urine is filled in a tube. The urine should be centrifuged at 3000 rpm for 5 minutes. After that supernatant is poured into a seperate tube. A small amount of sediment is placed on a slide. Sediment is evaluated with the microscope with phase lenses at 400x. At least 5 high power fields are assessed.

Stepwise evaluation of urinary sediment:

Cells Hematuria: screening test dipstick positiv for blood possible causes: hemoglobin, myoglobin, red blood cell urinary sediment red blood cells ( cut off >4 red cells per HPF ) glomerular origin if 30% of red cells dysmorphic or 5% acanthocytes

Pyuria: screening test dipstick positiv for leucocytes neutrophils, eosinophils or lymhocytes

Epithelial cells: renal tubular cells diagnostically significant

Casts All cast have an organic matrix composed primarily of Tamm-Horsfall mucoprotein

hyaline casts: not indicative for disease, observed in concentrated urine

red cell casts: diagnostic of glomerulonephritis or vasculitis

white cell casts: tubulointerstitial disease, acute pyelonephritis or many glomerular diseases

Fatty casts: significant proteinuria, „malteser cross“

Granular casts: represent degenerating cellular casts

Waxy casts: degeneration of granular casts, in advance renal failure

Bacteria often contamination, mycelien or Trichomonades

Crystalls typical uric acid, calcium phosphate or calcium oxalate crystalls SummaryThe diagnostic value of the urinalysis in patient with renal disease lies in the association between different pattern of urinary findings, the clinical findings and additional laboratory analysis.

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Workshop 8.1 & 8.2 - Donnerstag | Jeudi 14.11.2013

Die Tuberkulose in der Schweiz: etwas Neues? | La tuberculose en Suisse: quoi de neuf?Jean-Pierre Zellweger, Fribourg15:00-16:00 Uhr (deutsch), 16:30-17:30 Uhr (français), Harder 1

Tuberculosis is a rare disease in Switzerland, but has not disappeared. Some 500 cases are registered each year, with slight variations but no decreasing tendency.

The majority of cases (72%) are notified among persons of foreign origin. The mean age of foreign patients is much lower (36 years) than the mean age of Swiss patients (61 years). The majority of cases were confirmed by culture. TB is a disease of young foreigners !

Cases of TB among migrants generally occur after the entry in the country, from reactivation of latent TB acquired before. The screening at the border discovers only a minority of cases. Careful attention to incurring symptoms and easy access to care must be maintained during the whole stay in the country for all foreign-born persons.

One of the major threats for public health in several regions of the world is the progressive increase in the number of cases resistant to first-line drugs (Multidrug-resistant TB or MDR-TB), even among patients who were never treated for TB before (primary resistance due to recent transmission). In Switzerland, some 1.5% of cases of TB are MDR-TB. The treatment is possible but long, difficult and very expensive. New drugs are under study but are not yet available.

Due to decreasing knowledge and experience with the diagnosis and management of TB, many cases are missed during several weeks or months and diagnosed at an advanced stage. Medical doctors are encouraged to share their questions with experts and refer to the existing Guidelines, available on line at www.tbinfo.ch

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Workshop 9.1 & 9.2 - Donnerstag | Jeudi 14.11.2013

SpirometrieMatthias Strupler, Nottwil15:00-16:00 Uhr, 16:30-17:30 Uhr, Brünig 1+2

Spirometry

Spirometry is a method of assessing lung function by measuring the volume of air a person can expel from the lungs after maximal inspiration.

Performing Spirometry:It is important to explain the purpose of the test to the patient and to describe clearly what the patient will be asked to do. It should be emphasized the importance of taking a full breath and blowing out as fast and hard and complete as possible.Patients should be seated comfortably in upright position and should be wearing a noseclamp. After a maximal inspiration, they should exhale as fast, hard and complete as possible. The procedure should be repeated until three acceptable and repeatable blows are obtained.

Interpretation:Several indices can be derived from Spirometry: FVC – Forced Vital Capacity – the total volume of air the patient can forcibly exhale in one breath FEV1 – Forced Expiratory Volume in One Second – the volume of air the patient is able to exhale in the first second of expiration FEV1/FVC – the ratio of FEV1 to FVC

Values of FEV1 and FVC are measured in liters and are also expressed as a percentage of the predicted values for that individual, based on age, height, sex and ethnicity.

Interpretation of spirometry involves looking at the absolute values of FEV1, FVC and FEV1/FVC but even more important at the percentage of the predicted values. The shape of the spirograms should also be taken into account. A spirogram can be plotted as a Volume-Time-Curve or a Flow-Volume-Curve. Especially the Flow-Volume-Curve provides a quick and simple check whether the quality of spiometry is satisfactory and whether or not an obstruction is present.

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Workshop 10.1 & 10.2 - Donnerstag | Jeudi 14.11.2013

Quels vaccins pour quels adultes?Alessandro Diana, Genève15:00-16:00 Uhr, 16:30-17:30 Uhr, Harder 2

Workshop on vaccination solving problems

In this workshop clinical situations will be adapted to the audience as they would be in their office with thier patient…

Each participant can participate voting for the best option just showing his color cartoon.

Every options will be discussed with the support of medical rationale and evidence data.

Participants are also welcome to share their own personal questions regarding vaccines and vaccinations.

A brief tutorial of how to use www.myvaccines.ch – the Swiss electronic vaccination record- will be given at the end of the workshop.

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Workshop 11.1 & 11.2 - Donnerstag | Jeudi 14.11.2013

Das schwierige Arbeitsunfähigkeits-ZeugnisAlexander Nydegger, Zürich15:00-16:00 Uhr, 16:30-17:30 Uhr, Grimsel 1+2

Musculoskelettal disorders (MSD) are a common cause for incapacity for work. If spontaneous recovery fails and usual care does not facilitate return to work (RTW), physicians are often confronted with difficult decisions. This workshop shows strategies on how to help your patients as a general practitioner(GP) to get back to their work.

Difficulties with assessing capacity for work in the GP consultation

Lack of time / lack of knowledge to assess working conditions thoroughly. Functional capacity deficits (lack of strength and endurance) are difficult to quantify (strength often underestimated, endurance often overestimated). Often a history of complaints precedes the first visit to the GP (but is not evident)! Several insurances involved with differing interests

When should you refer your patient to a specialist? MSDs and one or several of the following issues:

Total incapacity for work > 6 weeks or recurrent short episodes off work. Failed RTW or persisting partial incapacity to work. Doubtful physical capacity for specific tasks or for labour market. Different estimation of capacity for work between employer / patient / physician.

Which Instruments exist to assess working capacity?

Assessment of Working capacity (Ambulantes Arbeitsassessment, USZ) Examination including thorough evaluation of workers tasks. Physical capacity evaluation with ECF-System (SAR) to match functional capacity with physical demands of the workplace. If necessary involvement of pychologist / social worker. Limitation: depends on patients willingness to cooperate/perform, no visit at the worplace => depends on patients /employers information, records, experience. Work Place Evaluation (Arbeitsplatzabklärung, APA) Visit to the workplace, estimation of charges according to a 14 item checklist Report with recommendations – no estimation of capacity for work! If necessary supplementary physical evaluation Limitations: you only see what is shown! Does not allow to estimate capacity for work (if no functional capacity evaluation data ist available) Certified Assessors for working capacity (ZAFAS) Practitioner with specific knowledge of insurance medicine and capacity eva-luation Consultant, does not treat the patient Involvement of case managers and medical consultants

Links / contact

for ECF and APA: http://sar-reha.ch/interessengemeinschaften/ig-ergonomie.html for insurance medcine: http://www.swiss-insurance-medicine.ch/de/zafas.html USZ: http://www.rheumatologie.usz.ch/UeberUns/Anmeldung/Seiten/default.aspx speaker: Alexander.Nydegger@usz.ch or Ergonomie@usz.ch

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Freitag | Vendredi 15.11.2013

Programm | Programme D F

08:30-10:00 Hauptvorträge | Chair: Jean-Michel Gaspoz, GenèveTheatersaal

08:30-09:00 Das (Kontakt)ekzem in der PraxisAndreas Bircher, Basel x

09:00-09:30 Nodules pulmonaires - que faire?Christoph von Garnier, Bern x

09:30-10:00 Lymphome: Was der Hausarzt wissen mussAndreas Lohri, Liestal x

10:00-10:30 Kaffeepause | Pause café

10:30-11:30Industrieforum | Colloque de l‘industrieBristol-Myers Squibb SA / Pfizer AG | Chair: François Mach | Theatersaal

Workshops 12-13 x

11:30-13:15 Lunch | Déjeuner

13:15-13:45 Plenar Session 9 | Chair: Susanna Stöhr, Luzern Theatersaal

Workshops 14-18

Hot topics Jörg D. Leuppi, Liestal x

13:15-13:45 Plenar Session 10 | Chair: Romeo Providoli, SierreBallsaal Akute BauchschmerzenRoland Bingisser, Basel x

13:45-14:15 Plenar Session 11 | Chair: Susanna Stöhr, LuzernTheatersaal Notfälle bei KindernDaniel Trachsel, Basel x

13:45-14:15 Plenar Session 12 | Chair: Romeo Providoli, SierreBallsaal Maladies thyroïdiennesChristoph A. Meier, Zürich x

14:15-14:45 Kaffeepause | Pause café

14:45-15:45 Workshops 14-23

15:45-16:15 Kaffeepause | Pause café

16:15-16:45 Plenar Session 13 | Chair: Jonas Rutishauser, Bruderholz | Theatersaal Workshops

19-23Neue AntikoagulantienEsther Bächli, Uster x

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Workshops 12-23 D F

12 Approach zum Patienten mit Schwindel Jens Jakscha, Basel x

13 Rationale Dyspnoeabklärung Ladina Joos, Basel x

14 Belastungs-EKG (Ergometrie) Peter Rickenbacher, Bruderholz x

15 ReanimationMarcus Laube, Biel/Bienne

xMartin Fischle, Biel/BienneHeinz Bussinger, Biel/Bienne

16 Kopfschmerz als Notfall Mark Emmenegger, Agno x

17 Gelenkuntersuchung René Zenhäusern, Zürich x

18 Motivation Alexander Kiss, Basel x

19 Nützliche Apps in der Praxis Grischa Marti, Bern x

20 Thorax-Röntgenbilder Carlos Buitrago Téllez, Zofingen x

21 Suture des plaies | WundversorgungAndreas Huber, Zürich x xMartin Haug, Basel

22 Statistik: Wie werden Papers gelesen? Peter Jüni, Bern x

23 Unerwünschte Arzneimittelwirkungen Anne Taegtmeyer, Basel x

Programm | Programme D F

16:15-16:45 Plenar Session 14 | Chair: Regula Capaul, ZürichBallsaal

Workshops19-23

Berufsassoziierte Lungenkrankheiten David Miedinger, Luzern x

16:45-17:15 Plenar Session 15 | Chair: Jonas Rutishauser, Bruderholz | TheatersaalLymphknotenvergrösserungGerd Laifer, Basel x

16:45-17:15 Plenar Session 16 | Chair: Regula Capaul, ZürichBallsaal ReisemedizinReto Nüesch, Luzern x

in deutscher Sprache en françaisD F

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Das (Kontakt)ekzem in der PraxisAndreas Bircher, Basel08:30-09:00 Uhr, Theatersaal

Kontaktekzeme und insbesondere Handkzeme stellen in vieler Hinsicht eine Herausforderung für die Behandlung und das Krankheitsmanagement dar: 1. Sie beeinträchtigen eine zentrale Funktion, was zu Einschränkungen im Beruf und persönlichen Umfeld führt. 2. Sie sind häufig, können Arbeitsunfähigkeit bedingen, und verursachen dadurch hohe direkte und indirekte Kosten für den Patienten, seinen Arbeitgeber und Versicherungsträger. 3. Sie werden ursächlich durch genetische und/oder Umwelteinflüsse ausgelöst, das heisst die Identifizierung und anschliessende Meidung auslösender Faktoren ist zentraler Bestandteil der Therapie. 4. Sie neigen bei verzögerter Diagnosestellung und Beginn einer effektiven Therapie zu Chronizität). Die Betreuung der Patienten mit Handekzem, insbesondere bei chronischem Verlauf, muss in enger Zusammenarbeit zwischen dem Hausarzt, dem Dermatologen und gegebenenfalls Arbeitsmediziner erfolgen. Das wichtigste Ziel ist, betroffene Patienten einer frühen und effektiven Behandlung zuzuführen. Dies bedeutet Abklärung der Ursachen, Vorbeugung von Rezidiven, und wenn möglich, Verhinderung chronischer Verläufe.Ekzeme präsentieren sich mit unterschiedlicher Morphe. Akute Ekzeme zeigen Juckreiz, Rötung und Schwellung, oft begleitet von dyshidrosiformen Bläschen, sowie Nässen und Krustenbildung. Chronische Ekzeme manifestieren sich mit Schuppung und Rhagaden bei geringerem Erythem mit Brennen und Juckreiz. Wichtigste Differentialdiagnosen sind die Tinea manuum und die Psoriasis. Erstere muss durch eine mykologische Untersuchung ausgeschlossen werden. Bei Verdacht auf Psoriasis ist das gesamte Integument nach den typischen erythematosquamösen Plaques zu untersuchen. Bei der Anamnese muss gezielt nach Kontaktallergenen und/oder irritativen Belastungen der Haut im Beruf, bei Hobbies, im Haushalt, Garten, bei der Körperpflege etc. gefragt werden. Bei Verdacht auf ein allergisches Kontaktekzem ist ein Epikutantest (Pflaster-/Patchtest) indiziert, bei dem die verdächtigen Substanzen in kommerziellen Testreihen und/oder vom Patienten mitgebrachten Materialien getestet werden. Topische Kortikosteroide verhelfen bei akuten Ekzemen zu einer raschen Besserung und Abheilung. 2 wichtige Punkte sind zu beachten: 1. Sog. rückfettende Basistherapie und 2. das Meiden auslösender Trigger. Spricht ein Handekzem nicht auf eine Kortikosteroidtherapie innerhalb von 3-4 Wochen an oder rezidiviert es nach Absetzen, müssen weitere Ursachen auf den Grund zu gehen und eine dermatologische Abklärung indiziert. Eine ununterbrochene Kortikosteroidtherapie ist wegen der Tachyphylaxie und der Entwicklung von lokalen Nebenwirkungen zu vermeiden. Mit der sogenannten Intervalltherapie kann das Risiko der Nebenwirkungen deutlich reduziert werden.

Weiterführende LiteraturHandekzeme: praktisches Vorgehen in Diagnostik und Behandlung Schweiz Med Forum 2013;13(23):453–458Kontaktekzem Schweiz Med Forum Nr. 18 2001: 458Atopische Dermatitis Schweiz Med Forum Nr. 19 2001 484

Hauptvortrag | Conférence principale - Freitag | Vendredi, 15.11.2013

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Nodules pulmonaires - que faire?Christoph von Garnier, Bern09:00-09:30 Uhr, Theatersaal

Solitary pulmonary nodule: What now?

A solitary pulmonary nodule (SPN) is defined as a rounded opacity with a diameter of less than 3cm, completely surrounded by lung parenchyma, without evidence for enlargened lymph nodes, atelectasis, or pleural effusion. SPN is a commonly encountered problem in clinical practice, often incidentally detected by conventional chest X-Ray or chest CT. Lung cancer screening studies report variable SPN frequencies between 8 - 51%, depending on the risk population targeted. Causes for SPN are classified either as benign (granuloma, infection, vasculitis, hamartoma) or malignant (primary lung cancer, metastatic cancer, carcinoid). The frequency for each of the causes depends on the patient population and regional variation.An ideal management of SPN consists in resecting malignant lesions, while avoiding operation for benign ones. Though this ideal approach is infrequently achieved, each patient with a SPN requires a careful diagnostic evaluation. This evaluation includes clinical and radiological features to formulate a probability for malignancy in a given SPN. In all cases, old imaging studies should be obtained to document either growth or stability of a SPN. Clinical features associated with increased probability for malignancy include patient age, as well as risk factory such as cigarette smoking, primary lung cancer, previous malignancy, asbestos exposure, and family history. Radiological characteristics associated with an increased risk or malignancy are nodule size, spiculated borders, and growth rate. FDG-PET is helpful in distinguishing benign from malignant nodules and detecting extra-thoracic lesions.If initial evaluation does not provide sufficient certainty that the lesion is benign or may be followed-up radiologically, sampling of the nodule is required. As patients with SPN are at higher risk for pre-malignant airways changes, a bronchoscopy, if necessary with combined electromagnetic navigation and endonbronchial ultrasound, should be performed. If the SPN cannot be sampled by brochoscopic means, the patient should undergo either a transthoracic needle CT-guided biopsy or direct surgical wedge resection. For the latter, cardiovascular and lung functional assessment is essential prior to operation that may eventually require lobectomy in case of malignancy.In summary, the SPN is a frequently encountered clinical problem requiring a diagnostic evaluation in each case. As SPN may lead to invasive diagnostic procedures, the diagnostic approach should be carefully discussed with the patient, taking into account risk for malignancy, co-morbidities, and patient preferences.

Hauptvortrag | Conférence principale - Freitag | Vendredi, 15.11.2013

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Lymphome: Was der Hausarzt wissen mussAndreas Lohri, Liestal09:30-10:00 Uhr, Theatersaal

Solitary pulmonary nodule: What now?Lymphome: was der Hausarzt wissen muss. Malignant lymphoma. What a GP needs to know.Ten items a GP may want to know about malignant lymphoma :

1. They are quite common. The Swiss cancer registries count about 1500 malignant lymphomas per year. As a group they are among the most common cancers but the WHO classification splits them down into 70 different entities. 2. Naming the specific diseases is difficult. Most often neither the GP nor the patient is able to name the disease by using a term that may be understandable to the patient and his relatives. Hodgkin lymphoma, formerly called Morbus Hodgkin is easy but so far no appropriate name has been found ie for diffuse large B cell lymphoma (DLBCL), the most common or for follicular lymphoma, the second most common malignant lymphoma. The Swiss society of lymphoma patients (www.lymphome.ch) provides specific information on 12 of the most common lymphomas. Patients are still told to have a « Non Hodgkin Lymphoma » although this term is obsolete. 3. Symptoms may be misleading. A global survey on the time from the first symptom to the diagnosis of the disease has revealed that many patients have symptoms for more than a year before the diagnosis of a lymphoma is made. The work up of a visible lump may be easy but about halve of the lymphomas are extranodal and they present with a large variety of symptoms be it neurologic/ocular in CNS lymphomas, cutaneous in T cell lymphoma, renal and cardiac in ie amyloid producing lymphomas, chronic back pain or leg edema in retroperitoenal disease etc. Typical B symptoms occur quite late but patients may complain about fatigue or depression. 4. The workup is best done in coordination with a specialist (oncologist or a hematologist) It usually includes a « good biopsy », a CT or a PET scan, blood tests including serologies for hepatitis (anti B cell treatment may reactivate hepatitis B) and HIV. 5.Treatment algorhythms are best planned in a multidisciplinary lymphoma conference. 6. Treatment is most often carried out by a specialist. Interim blood counts and administration of growth factors and antibiotics can be done in a GPs office.7.The common regimens are still ABVD and BEACOPP for Hodgkins and CHOP with the Anti B cell antibody Rituximab (Mabthera) for many other lymphomas. The number of drugs has increased considerably. Bendamustin combinations have become more popular for indolent lymphomas. This drug has an excellent therapeutic index with cytopenia and skin rash as the main toxicities. Radiation therapies are used less often in the curative setting because of their late effects. 8.The prevalence of lymphoma patients is increasing because they more often have a chronic course. Fortunately the number of lymphoma survivers is increasing, so more patients will be seen by a GP in a private practice. 9. There are no clear guidelines for a long term follow up of lymphoma patients. Flu and pneumococcal vaccinations are recommended. Some advise vaccinations for meningitis and hemophilus. Even long term survivers remain prone to infections, sometimes presenting with unusual syndroms (CMV, atypical Tb etc).10. New aspects are evolving ie new drugs such as ibrutinib (« Glivec for B cell lymphomas »), pretreatment oocyte preservation or new ethical questions such as family planning in young patients with chronic malignant lymphomas !

Hauptvortrag | Conférence principale - Freitag | Vendredi, 15.11.2013

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Notfälle bei KindernDaniel Trachsel, Basel13:45-14:15 Uhr, Theatersaal

Pediatric emergencies

This workshop aims at improving the clinical recognition of impending internistic emergencies in children and offers a concise overview of current approaches to a variety of selected acute pediatric diseases.

Plenar Session 11 - Freitag | Vendredi, 15.11.2013

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Maladies thyroïdiennesChristoph A. Meier, Zürich13:45-14:15 Uhr, Ballsaal

Plenar Session 12 - Freitag | Vendredi, 15.11.2013

27.09.13  

1  

Novel Antidiabetics: Should they be used at all -

and in whom? Prof. Christoph A. Meier

Dept. of Internal Medicine & Specialities

Euthroid  sick  syndrome  (ESS)  ¥  sick  pa/ents  present  with  the  picture  of  central  hypothyroidsm  (low,  but  not  suppressed,  TSH;  low  T3  and  T4)  combined  with  a  block  of  the  conversion  of  T4  to  T3  

¥  it  is  very  difficult  to  dis/nguish  ESS  from  true  central  hypothyroidsm  or  subclinical  hyperthyroidism;  this  DD  must  be  made  solely  on  clinical  grounds!  

¥  Hence,  avoid  measuring  thyroid  func/on  tests  in  sick  pa/ents  (par/cularly  in  the  ICU)  without  a  good  reason  

Hypothyroidism:  Diagnos:c  work-­‐up  ¥  Clinical  suspicion  ¥  Careful  history:  Thyroid  opera/on?  Radioiodine  treatment?  Drugs  (e.g.  amiodarone,  lithium,  interferon),  nutri/on  (chronic  iodine  excess,  e.g.  kelp)  

¥  Careful  exam:  scar  in  the  neck,  vi/ligo,  alopecia?  Evidence  of  adrenal  or  ovarian  failure?  

¥  TSH;  if  abnormal,  add  fT4.  Measure  T3  or  an/-­‐TPO  only  in  very  selected  cases  

¥  no  ultrasound!!!    

Hypothyroidism:  Therapy  ¥  in  non-­‐pregnant  pa/ents  a  TSH    >10  mU/L  requires  treatment,  even  if  no  symptoms  are  present.  In  planned  or  current  pregnancy,  the  TSH  should  be  0.5  –  2.0  mU/L  

¥  a  TSH  <6  mU/L    should  usually  not  be  treated  (personal  opinion)  

¥  Star/ng  dose  of  T4:  a  typical  star/ng  dose  is  50-­‐75  µg/d;  the  higher  the  TSH,  the  more  careful  you  have  to  be  (myocardial  ischemia)!  

¥  check  TSH  (+/-­‐  fT4)  4-­‐6  we  later  and  adapt  dose    

27.09.13  

1  

Novel Antidiabetics: Should they be used at all -

and in whom? Prof. Christoph A. Meier

Dept. of Internal Medicine & Specialities

Euthroid  sick  syndrome  (ESS)  ¥  sick  pa/ents  present  with  the  picture  of  central  hypothyroidsm  (low,  but  not  suppressed,  TSH;  low  T3  and  T4)  combined  with  a  block  of  the  conversion  of  T4  to  T3  

¥  it  is  very  difficult  to  dis/nguish  ESS  from  true  central  hypothyroidsm  or  subclinical  hyperthyroidism;  this  DD  must  be  made  solely  on  clinical  grounds!  

¥  Hence,  avoid  measuring  thyroid  func/on  tests  in  sick  pa/ents  (par/cularly  in  the  ICU)  without  a  good  reason  

Hypothyroidism:  Diagnos:c  work-­‐up  ¥  Clinical  suspicion  ¥  Careful  history:  Thyroid  opera/on?  Radioiodine  treatment?  Drugs  (e.g.  amiodarone,  lithium,  interferon),  nutri/on  (chronic  iodine  excess,  e.g.  kelp)  

¥  Careful  exam:  scar  in  the  neck,  vi/ligo,  alopecia?  Evidence  of  adrenal  or  ovarian  failure?  

¥  TSH;  if  abnormal,  add  fT4.  Measure  T3  or  an/-­‐TPO  only  in  very  selected  cases  

¥  no  ultrasound!!!    

Hypothyroidism:  Therapy  ¥  in  non-­‐pregnant  pa/ents  a  TSH    >10  mU/L  requires  treatment,  even  if  no  symptoms  are  present.  In  planned  or  current  pregnancy,  the  TSH  should  be  0.5  –  2.0  mU/L  

¥  a  TSH  <6  mU/L    should  usually  not  be  treated  (personal  opinion)  

¥  Star/ng  dose  of  T4:  a  typical  star/ng  dose  is  50-­‐75  µg/d;  the  higher  the  TSH,  the  more  careful  you  have  to  be  (myocardial  ischemia)!  

¥  check  TSH  (+/-­‐  fT4)  4-­‐6  we  later  and  adapt  dose    

27.09.13  

2  

Hyperthyroidism:  Diagnos:c  work-­‐up  ¥  Clinical  suspicion  ¥  Careful  history:  Drugs  (e.g.  amiodarone,  lithium,  interferon,  contrast  media)?    

¥  Careful  exam:  signs  of  hyperthyroidism?  Goiter  (painful?),  nodules?  Signs  of  endocrine  orbitopathy?  pre/bial  myxedema?  

¥  TSH;  if  abnormal,  add  fT4;  if  fT4  is  normal,  T3  ¥  depending  on  context,  perform  thyroid  scin/graphy  (DD:  Graves's/Basedow,  autonomy,  throidi/s)  

Hyperthyroidism:  Therapy  ¥  Thyroidi/s:  wait  and  seen;  beta-­‐blockers,  if  symptoma/c  

¥  Autonomy  (unique  nodule  or  mul/nodular  goiter):  radioiodine  or  surgery  

¥  Graves'/Basedow:  an/-­‐thyroid  drugs,  radioiodine,  surgery  (pa/ent  preference!)  

¥  a  typical  star/ng  dose  for  Neo-­‐Mercazole  is  15-­‐30  mg/d  depending  on  context;  cave  side-­‐effects!!!  

¥  recheck  TSH  and  fT4  about  2  weeks  later  

Thyroid  nodules  ¥  try  to  forget  inciden/ally  discovered  nodules  <1.5  cm;  follow-­‐up  by  palpa/on.  However,  this  is  difficult  in  an  over-­‐medicalized  country  in  2013!  

¥  Nodules  >1.5  cm  (or  smaller  in  pa/ents  with  risk  factors:  family/gene/c  history,  external  radiotherapy)  should  usually  be  subjet  to  a  fine-­‐needle  aspira/on  

¥  Management  according  to  cytology  ¥  Avoid  US-­‐follow-­‐up  and  re-­‐biopsy  for  benign  nodules  without  clinically  significant  growth  

27.09.13  

2  

Hyperthyroidism:  Diagnos:c  work-­‐up  ¥  Clinical  suspicion  ¥  Careful  history:  Drugs  (e.g.  amiodarone,  lithium,  interferon,  contrast  media)?    

¥  Careful  exam:  signs  of  hyperthyroidism?  Goiter  (painful?),  nodules?  Signs  of  endocrine  orbitopathy?  pre/bial  myxedema?  

¥  TSH;  if  abnormal,  add  fT4;  if  fT4  is  normal,  T3  ¥  depending  on  context,  perform  thyroid  scin/graphy  (DD:  Graves's/Basedow,  autonomy,  throidi/s)  

Hyperthyroidism:  Therapy  ¥  Thyroidi/s:  wait  and  seen;  beta-­‐blockers,  if  symptoma/c  

¥  Autonomy  (unique  nodule  or  mul/nodular  goiter):  radioiodine  or  surgery  

¥  Graves'/Basedow:  an/-­‐thyroid  drugs,  radioiodine,  surgery  (pa/ent  preference!)  

¥  a  typical  star/ng  dose  for  Neo-­‐Mercazole  is  15-­‐30  mg/d  depending  on  context;  cave  side-­‐effects!!!  

¥  recheck  TSH  and  fT4  about  2  weeks  later  

Thyroid  nodules  ¥  try  to  forget  inciden/ally  discovered  nodules  <1.5  cm;  follow-­‐up  by  palpa/on.  However,  this  is  difficult  in  an  over-­‐medicalized  country  in  2013!  

¥  Nodules  >1.5  cm  (or  smaller  in  pa/ents  with  risk  factors:  family/gene/c  history,  external  radiotherapy)  should  usually  be  subjet  to  a  fine-­‐needle  aspira/on  

¥  Management  according  to  cytology  ¥  Avoid  US-­‐follow-­‐up  and  re-­‐biopsy  for  benign  nodules  without  clinically  significant  growth  

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Berufsassoziierte LungenkrankheitenDavid Miedinger, Luzern16:15-16:45 Uhr, Ballsaal

Occupational diseases of involving the respiratory tract are frequent and cause substantial morbidity. In Switzerland Suva is the organization that is responsible for the prevention of occupational diseases in all companies. On suspicion of a occupational disease the employer or patient must report this suspicion to their insurer („UVG-Versicherer“). The insurer will then have to determine the causality and if the disease can be accepted as of occupational origin under the Swiss law (Unfallversicherungsgesetz, UVG). The frequency of work-related asthma 1-2 out of 10 adults with asthma. It is important to determine the cause of the asthma (sensitization to a workplace agent or accidental exposure to high concentrations of an airway irritant). Peakflow measures can help to diagnose occupational asthma and to determine the exacerbating factors. In individuals with sensitization to a workplace agent, guidelines suggest that the offending agent or the asthmatic worker must be removed from the workplace. However an individual assessment is needed as some workers can remain in the workplace if technical, organizational measures or adequate personal protection equipment are shown to be successful. The time a worker remains in the workplace having asthma symptoms is an important prognostic factor. Thus specialist investigation needs to be initiated in an early stage.Asbestos-related lung diseases manifest 20-40 years after exposure to asbestos fibres. The most frequent and benign condition is local pleural thickening - so called „pleural plaques“. Asbestos related pleural effusions, pleural thickening and rounded atelectasis are conditions where broad differential diagnosis must be considered. Mesothelioma is a very aggressive cancer where medical screening programs have not yet yielded a benefit in mortality. Bronchial carcinoma is related to exposure to cigarette smoke and exposure to substances in the workplace such as asbestos, polycyclic aromatic hydrocarbons, nickel and chromium. Screening for lung cancer with low-dose computed tomography in individuals with high risk for bronchial carcinoma has been shown to reduce all-cause and lung cancer mortality.

Further information on work-related asthma: Arbeitsplatz-assoziiertes Asthma: Abklärung, Diagnose und Management. Swiss Medical Forum Ausgabe 47, 2012: http://www.medicalforum.ch/docs/SMF/2012/47/de/smf-01328.pdfFurther information on asbestos-related lung disease: Factsheet Asbestbedingte Berufskrankheiten: http://www.suva.ch/factsheet-asbestbedingte-berufskrankheiten.pdf

Plenar Session 14 - Freitag | Vendredi, 15.11.2013

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LymphknotenvergrösserungGerd Laifer, Basel16:45-17:15 Uhr, Theatersaal

Gerd Laifer (Basel): Lymphadenopathy

The human body harbours >600 lymph nodes. Lymph nodes <1 cm are frequently palpable in the cervical, axillary or inguinal region in healthy individuals. Only few diseases present predominantly as a peripheral lymphadenopathy (LAP), defined as enlarged (>1 cm) lymph nodes or lymph nodes altered in number or consistency. Unexplained LAPs represent a diagnostic dilemma, since the differential diagnosis is broad, only few diseases will be either severe or treatable, but patients and their doctors are in fear of missing a relevant diagnosis (e.g. malignancy). For further investigations an algorithm which distinguishs between localised and generalised lymphadenopathies is proposed (s. below; from Richner S & Laifer G; Swiss Med Weekly 2010;140:98):

Localised diseases (75%) are often caused by a specific pathology in the area of drainage, which can be diagnosed without additional investigations. If the diagnosis is unclear, the patient is clinically stable and there is no suspicion of malignancy, it is safe to wait for 3-4 weeks and observe the clinical course. Exceptions are supra- and infraclavicular lymph nodes, which are always suspicious of an underlying malignancy.

Generalised lymphadenopathies (25%) are often a sign of a significant underlying disease. A diagnosis of lymphoma, malignancy, HIV infection or tuberculosis should nor be missed or delayed. Excisional biopsy is regarded as the diagnostic method of choice, since it allows an assessment of the architecture of the lymph node as well as histological, immunohistochemical, cytogenetic and molecular investigations.

Plenar Session 15 - Freitag | Vendredi, 15.11.2013

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ReisemedizinReto Nüesch, Luzern16:45-17:15 Uhr, Ballsaal

Definition and importance An interdisciplinary speciality concerned with prevention, early detection and research of health problems associated with travel Among 100‘000 travellers to developing world for 1 month 50’000 will develop some health problem during the trip 8’000 will see a physician 5’000 will be confined to bed 1’100 will be incapacitated in their work 300 will be hospitalized 50 have to be evacuated 1 will die

Relative incidence of health problems during the trip: Traveller’s diarrhoea (20%-60%) Respiratory tract infections (5%-20%) Accidents (5%) Skin diseases (5%) Malaria (2%) Dengue (0.1%) Hepatitis A (0.03-0.3%) Animal bites, potential rabies risk (0.3%)

Population at risk: Pregnant women, children and elderly, disabilities, chronic diseases, immunosupression

Causes of mortality in travellers: Cardiovascular > accidents > medical > cancer > unknown > suicide > Infections

Pre and post travel advice Pre travel: concomitant diseases, vaccines, eating and drinking habits, insect bites, malaria, STD, air travel, sun protection, high altitude Returning traveller: no systematic screening, symptom oriented diagnosis based on travel history and epidemiology

Health problems in the returning traveller: Fever (23%): malaria, dengue, rickettsiosis, typhoid, HIV, EBV Acute diarrhoea (22%): bacteria, parasites Skin (17%): bites and stings, larva migrants, allergies, skin and soft tissue infection, tinea Other GI disorders (8%): helminthic infections, peptic ulcer, hepatitis Chronic diarrhoea (7%) Respiratory symptoms (4%) Unspecific symptoms (4%) Genital and urinary tract (2%) Worsening of pre-existing condition (1%) Injuries (1%)

Information www.safetravel.ch www.fevertravel.ch BAG: www.bag.admin.ch www.istm.org

Plenar Session 16 - Freitag | Vendredi, 15.11.2013

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Workshop 12 - Freitag | Vendredi, 15.11.2013

Approach zum Patienten mit SchwindelJens Jakscha, Basel10:30-11:30 Uhr, Ballsaal

Patienten, welche über Schwindel klagen, sind in der Praxis keine Seltenheit.In diesem Workshop soll erarbeitet werden, welche Fragen Patienten mit Schwindel gestellt werden sollten. Dazu gehören unter anderem Dauer, Häufigkeit, auslösende Faktoren, Begleitsymptome und Medikamente.Zudem werden Untersuchungstechniken wie die grob neurologische Prüfung, die Beurteilung von Spontan- und Provokationsnystagmen, die Lage- und Lagerungsprüfung demonstriert. Dabei wird auch auf den Kopfimpulstest nach Halmagyi eingegangen. Anschliessend besteht die Möglichkeit häufige Krankheitsbilder und allfällige weiterführende Diagnostik zu diskutieren.

Patients who complain of dizziness and vertigo are not uncommon in the medical practice. In this workshop, the questions that should be asked patients with these complaints will be examined in detail. These cover duration and frequency of symptoms, precipitating factors, associated symptoms and medication.Investigational techniques, such as otoneurological examinations, assessment of spontaneous, provoked and positioning nystagmus will be demonstrated, including the impulse test of Halmagyi. At the end there will be a possibility to discuss frequent case-histories and any necessary additional diagnostic techniques.

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Workshop 13 - Freitag | Vendredi, 15.11.2013

Rationale DyspnoeabklärungLadina Joos, Basel10:30-11:30 Uhr, Club Casino

Rationale Dyspnoeabklärung | Dyspnea – rational work-up

Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.

The causes of acute dyspnea comprise medical emergencies such as pneumothorax, pulmonary embolism or acute cardiac ischemia.

Chronic dyspnea is often caused by cardiac or pulmonary disorders such as asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure and chronic obstructive pulmonary disease. Metabolic or neurological disorders can also lead to dyspnea. Psychogenic causes, such as panic attacks, are frequent but remain a diagnosis of exclusion.

In this workshop, we will discuss the pathophysiology, differential diagnosis and the clinical approach to evaluate patients with dyspnea.

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Workshop 14.1 & 14.2 - Freitag | Vendredi, 15.11.2013

Belastungs-EKG (Ergometrie)Peter Rickenbacher, Bruderholz13:15-14:15 Uhr, 14:45-15:45 Uhr, Kongresssaal 1

Introduction

Due to its practicability, wide availability and good cost-benefit ratio, the exercise-ECG is recommended as the initial test for establishing a diagnosisof stable coronary disease in patients with symptoms of angina and intermediate pretest probability unless they cannot exercise or display ECG changes at rest which make the ECG non evaluable. The main diagnostic ECG abnormality during exercise testing consists of a horizontal or down-slo-ping ST-segment depression ≥0.1mV, persisting for at least 0.06–0.08s after the J-point, in one or more ECG leads. The test also provides additional information, such as heart rate and blood pressure response, symptoms, arrhythmias and workload achieved, which has both diagnostic and prognostic relevance. Complications are rare if the test is performed by trained and experienced professionals according to guidelines with implementation of safety precautions and consideration of contraindications. Limitations include moderate sensitivity.

AimsThe subject will be discussed based on practical clinical examples in an interactive way. After the workshop participants will be able to appropriately select candidates for exercise-ECG and know the advantages / limitations of the test know indications, contraindications and reasons for termination know the requirements in staff and equipment be able to interpret and document exercise ECG’s

ReferencesThe Task Force on the management of stable coronary artery disease of the European Society of Cardiology.2013 ESC guidelines on the management of stable coronary ar-tery disease.Eur Heart J 2013 (in press).

Handschin R, Rickenbacher P. Stabile Angina pectoris: nicht invasive Diagnostik.Schweiz Med Forum 2010;10:621-5.

ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Available at: www.acc.org/clinical/guidelines/exercise/dirIndex.htm.

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Workshop 15 - Freitag | Vendredi, 15.11.2013

ReanimationMarcus Laube, Martin Fischle, Heinz Bussinger; Biel | Bienne13:15-15:45 Uhr, Kongresssaal 4

Cardiopulmonary Resuscitation (CPR) / “Reanimation”Just do it! And do not hesitate! Time is life! No-Flow-time matters!

Based on the current guidelines published in 2010 entitled “2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science” the workshop will allow you to train in common situations in the field of CPR with emphasis on BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support). The aim is to practice on three workstations with simulated models equipped with defibrillator and feedback tools. The course will challenge you under supervision to “save the life of the patient”. The latest guidelines intend to motivate and to empower every potential rescuer to perform rapidly an effective CPR. The most important part is the BLS followed by the ACLS. There is increased focus on methods to ensure that high-quality CPR is performed, and you are encouraged to develop a widespread culture of high quality resuscitation. The guidelines try to teach simple techniques so that the no-flow-time is as short as possible and that the time-consuming acts interrupting the chest compression are eliminated. The concept of building blocks of CPR is introduced based on rescuer proficiency – formally allowing the rescuer to do what he can depending on his/her education. The range goes from hand-only CPR over 30:2 CPR to multi-rescuer coordinated CPR. Emphasis is put on an early CPR start – an unusual breathing pattern is reason enough to start CPR! The role of the CPR team leader is emphasized.

Mnemonic for the cycle in ACLS:

Sources of knowledge and full text papers : http://www.resuscitation.ch(Swiss resuscitation council; Documents in German AND French) ; http://www.ilcor.org

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Workshop 16.1 & 16.2 - Freitag | Vendredi, 15.11.2013

Kopfschmerz als NotfallMark Emmenegger, Agno13:15-14:15 Uhr, 14:45-15:45 Uhr, Club Casino

Headache as case of emergency

Ask the right QUESTONS to find out dangerous causes of headaches: How many different types of headache? What is the typical headache like?

Time questions. Why consulting now? How recent is onset? The temporal pattern? If the headaches are episodic, frequency, periodicity? How long for maximum and how long it lasts?

Character questions. Intensity, nature quality (throbbing or tension) and severity of headache, sight, associated symptoms, aggravation of headache, headache that wakes up?

Cause questions. What ideas has the P about the cause of headache? Predisposing/ trigger factors?

Response questions. What do you do when you get a headache? What medication has been used and is being used?

State of health between attacks. What other medical or neurological problem does exist? Concerns, anxieties, depression, change of personality/daily habits, family history similar headache, aneurysm?

Remember the RED FLAGS: “S S N O O P T” for dangerous headaches:

S Systemic symptoms Hypertension, signs of sepsis, fevers, rash, muscle pain, weight loss, neck pain, stiffness, rhinorrhoea, lacrimation, dehydration, infection, signs of shock, lymphadenopathy, pregnancy, preeclampsia, hypoglycemia, vertigo …

S Secondary risk factors Head trauma, HIV, immunosuppression, cancer, anticoagulation, smoking, C2, contraceptives...

N Neurological Signs or Symptoms Any headaches associated with changes of cognition or mental functioning: Confusion, impaired alertness, drowsy, persistent focal signs (lasting more than 1 hour), weakness, vision changes, diplopia, papilledema, scotoma, syncope, sleepiness, seizures, pulsatile tinnitus, red eye and halos around lights, meningism, ataxia, gait disorders, speech symptoms ..

O Onset Any headaches that hit suddenly and severely, without warning (“thunderclap headaches”). If straining, coughing, sneezing or sexual activity causes a headache to appear. Onset “First and worst headache”, sudden or abrupt from sleep or progressively worsening.

O Older Age of Onset If new headache first starts after 30 years of age simple migraines is still possible but not likely. After age 50: giant cell arteritis, subdural bleeding, haemorrhages, mass lesion, vasculitis, hydrocephalus.

P Prior Headache History If headache pattern has changed. Previous headache history. First headache or fundamentally different (i.e. significant change in features, frequency, or severity).

T Triggered headache If headache is triggered by drugs, valsalva activity, exertion, bending over, laying down...

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Workshop 17.1 & 17.2 - Freitag | Vendredi, 15.11.2013

GelenkuntersuchungRené Zenhäusern, Zürich13:15-14:15 Uhr, 14:45-15:45 Uhr, Kongresssaal 2

Physical Examination of the articulation

In this practical workshop, candidates will be taught how to carry out a detailed physical examination of the hip joint.The active assessment of the smaller skeletal joints of the body may be covered according to interest and demand.Participants will be required to work in pairs under observation, during the course of this workshop, aiming to give constructive feedback in roleplaying as both examinee and examiner.

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Workshop 18.1 & 18.2 - Freitag | Vendredi, 15.11.2013

MotivationAlexander Kiss, Basel13:15-14:15 Uhr, 14:45-15:45 Uhr, Harder 1

In the interactive workshop the participants will work on what makes a patient motivated or unmotivated. The same procedure will be used to find what makes a physician motivated or unmotivated.

In the second part, empirical studies will be presented on the (medical) consequences of motivated and unmotivated patients and physicians.

In the third part, the participants will work on their personal experience of making unmotivated patients motivated and on their personal ways of motivating themselves.

In the fourth part, empirical studies will be presented on how to motivate patients with a specific focus on motivational interviewing with its benefits and shortcomings.

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Workshop 20.1 & 20.2 - Freitag | Vendredi, 15.11.2013

Thorax-RöntgenbilderCarlos Buitrago Téllez, Zofingen14:45-15:45 Uhr, 16:15-17:15 Uhr, Grimsel 1+2

Chest x-raySummery

Contents Basics examination technique/ dose aspects Introduction to systematic analysis of chest x-rays Image interpretation – interactive Quiz with discussion of differential diagnosis Clinic-radiological correlation Description and detection of basic patterns of pathologic findings on chest x-rays with CT correlation of important signs

After the workshop the participant will be able to analyse and interpretate systematically a chest x-ray taking into consideration most common disease patterns. The goal ist to be able to make a correct differential diagnosis based on chest x-ray image analysis and make the final diagnosis or a proper indication for further CT imaging examination.

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Workshop 23.1 & 23.2 - Freitag | Vendredi, 15.11.2013

Unerwünschte ArzneimittelwirkungenAnne Taegtmeyer, Basel14:45-15:45 Uhr, 16:15-17:15 Uhr, Brünig 3

Patients often present with new symptoms which may or may not be caused by drug therapy. This interactive workshop will explore methods for determining whether a symptom is related to medication use or not and discuss management options by using cases referred to our clinical pharmacology service. Participants will be taught how to perform a formal pharmacovigilance assessment and practical tips on where to get help when faced with such cases in busy every day clinical practice will also be given.

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Referentenliste | Liste des orateurs

BPD Dr. med. Esther BächliSpital UsterBrunnenstrasse 42CH-8610 Uster

Dr. med. Torsten BerghändlerPraxisgemeinschaft WelterhausPlatz 12CH-9100 Herisau

Prof. Dr. med. Roland BingisserUniversitätsspital BaselCA NotfallstationPetersgraben 4CH-4031 Basel

Prof. Dr. med. Andreas BircherUniversitätsspital Basel Allergologische PoliklinikPetersgraben 4CH-4031 Basel

Dr méd. Hans-Jürg BoppRoute de Marchissy 3CH-1261 Le Vaud

Prof. Dr. med. Carlos Buitrago TéllezSpital Zofingen AGMühletalstrasse 27CH-4800 Zofingen

Dr. med. Heinz BussingerSpitalzentrum BielIm Vogelsang 84CH-2502 Biel|Bienne

Dr. med. Felix BurkhalterUniversitätsspital BaselPetersgraben 4CH-4031 Basel

DDr méd. Alessandro DianaHUGPédiatreCH-1211 Genève

EDr. med. Jens EcksteinUniversitätsspital BaselPetersgraben 4CH-4031 Basel

Dr. med. Marc EgliCentre médical de VichyRoute de Chavannes 11CH-1007 Lausanne

Dr. med. Mark EmmeneggerStudio MedicoWorld Trade CenterCH-6982 Agno

FDr. med. Claude FischerKantonsspital GraubündenDepartement ChirurgieLoestrasse 170CH-7000 Chur

Dr. med. Martin FischleSpitalzentrum BielIm Vogelsang 84CH-2502 Biel|Bienne

GPr Dr méd.Jean-Michel GaspozHUG, Départementde médecine communautaireRue Gabrielle-Perret-Gentil 4CH-1211 Genève

Pr Dr méd. Daniel GennéHôpital Neuchâtelois Département de médecine interneRue du chasseral 20CH-2300 La Chaux-de-Fonds

HProf. Dr. med. Walter HäfeliUniversitätsklinikum HeidelbergIm Neuenheimer Feld 410D-69120 Heidelberg

PD Dr. med. Karl HamplSpitalzentrum BielVogelsang 84CH-2501 Biel|Bienne

Prof. Dr. med. Andreas Huberah-artmedEichstrasse 47ACH-8712 Stäfa

Dr. med. Jörg HumburgKantonsspital BruederholzFrauenklinikCH-4101 Bruderholz

PD Dr. med. Martin HaugUniversitätsspital BaselSpitalstrasse 21CH-4031 Basel

JDr. med. Jens JakschaUniversitätsspital BaselPetersgraben 4CH-4031 Basel

Prof. Dr. med. Peter JüniInstitut für Sozial- und PräventivmedizinFinkenhubelweg 11CH-3012 Bern

Dr. med. Ladina Joos ZellwegerClaraspitalKleinriehenstrasse 30CH-4058 Basel

KProf. Dr. med. Alexander KissUniversitätsspital BaselPetersgraben 4CH-4031 Basel

LDr. med. Gerd LaiferPraxisBläsiring 160CH-4057 Basel

Dr. med. Marcus LaubeSpitalzentrum Biel AGVogelsang 84CH-2501 Biel|Bienne

Prof. Dr. med. Jörg D. LeuppiKantonsspital BasellandRheinstrasse 26CH-4410 Liestal

Prof. Dr. med. Andreas LohriKantonsspital BasellandRheinstrasse 26CH-4410 Liestal

MDr. med. Grischa MartiInselspital BernFreiburgstrasse CH-3010 Bern

Prof. Dr. med.Christoph A. MeierTriemli SpitalBirmensdorferstrasse 497CH-8063 Zürich

Dr. med. David MiedingerSUVAFluhmattstrasse 1CH-6002 Luzern

Dr. med. Alfred E. MüllerSchulthess Klinik, NeurologieLengghalde 2CH-8008 Zürich

NDr. med. Marco NegriAdelbodenstrasse 29CH-3714 Frutingen

Prof. Dr. med. Reto NüeschÄrztehaus Lützelmatt (Trakt L)Infektiologische und internistische PraxisSt. Anna-Strasse 32CH-6006 Luzern

Dr. med. Alexander NydeggerUniversitätsSpital ZürichRämlistrasse 100CH-8091 Zürich

RProf. Dr. med. Peter RickenbacherKantonsspital Bruderholz KardiologieCH-4101 Bruderholz

Prof. Dr. med. Frank RuschitzkaUniversitätsSpital Zürich KardiologieRaemistrasse 100CH-8091 Zürich

Prof. Dr. med. Jonas RutishauserKantonsspital Bruderholz Medizinische UniversitätsklinikCH-4101 Bruderholz

SDr. med. Salomé SchafrothUniversitätsspital BaselPetersgraben 4CH-4031 Basel

PD Dr. med. Urs SchwarzUniversitätsSpital ZürichKlinik für NeurologieFrauenklinikstrasse 26CH-8091 Zürich

TDr. med. Anne TaegtmeyerUniversitätsspital BaselPetersgraben 4CH-4031 Basel

PD Dr. med. Daniel TrachselUniversitäts-Kinderspital beider BaselPneumologie/IntensivstationSpitalstrasse 33CH-4056 Basel VPD Dr. med.Christophe von GarnierInselspitalPneumologieFreiburgstrasse CH-3010 Bern

ZDr méd. Jean-Pierre ZellwegerPneumologue FMHRue de Locarno 1CH-1700 Fribourg Dr. med. René ZenhäusernFacharzt FMH für Physikalische Medizin u. RehabilitationRehazenoForchstrasse 51CH-8032 Zürich

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Raumübersicht | Vue des salles

Einga

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Sekretariat

Plenum(Theatersaal)

OG | UG

Kongresssaal1

Kongresssaal2

Kongresssaal3

Kongresssaal4

EG

WC

WC

WC

EG

Brünig 1-2Brünig 3

Grimsel 1

Grimsel 2

Harder 1

Harder 2

Susten

Rugen

Club CasinoBallsaal

Induestrieausstellung(Konzerthalle)

Erdgeschoss | Rez-de-chaussée

Untergeschoss | Sous-sol

Obergeschoss | Étage supérieur

Bluthochdruck

COVERAM®. Z: Perindopril Arginin (ACE-Hemmer) und Amlodipin besilat (Kalziumantagonist). Tabletten zu 5 mg/5 mg, 5 mg/10 mg, 10 mg/5 mg, 10 mg/10 mg Perindopril/Amlodipin. I: Behandlung der essentiellen arteriellen Hypertonie und/oder der stabilen koronaren Herzkrankheit, als Ersatz bei Patienten, die mit der freien Kombination von Perindopril und Amlodipin in gleichen Dosierungen bereits eingestellt sind. D: Eine Tablette täglich am Morgen vor dem Frühstück. KI: Überempfi ndlichkeit gegenüber Perindo-pril, anderen ACE-Hemmern, Amlodipin, anderen Dihydropyridinen oder einem der Hilfsstoffe, Angioödem unter einer früheren Behandlung mit einem ACE-Hemmer, hereditäres oder idiopathisches Angioödem, Schwangerschaft und Stillzeit, niereninsuffi ziente Patienten mit einer Kreatinin-Clearance < 30 ml/Min. VM: Hypotonie, Hämodialyse, Desensibilisierung gegenüber Hymenopterengiften, renovaskuläre Hypertonie, Überempfi ndlichkeit, Chirurgie/Anästhesie, Hypoglykämie. IA: Vorsicht bei gleichzeitiger Ver-abreichung von Arzneimitteln, die den Kaliumhaushalt beeinfl ussen. Weitere IA: Kaliumsparende Diuretika: Gleichzeitige Verabreichung von Lithium erfordert eine strenge Überwachung des Lithiumplasmaspiegels. Grapefruitsaft. Orale Antidiabetika. Zu Beginn einer gleichzeitigen Verabreichung den Blutspiegel von Theophyllin oder Ergotamin regelmässig kontrollieren. UW: Kopfschmerzen, Schwindel, Asthenie, Parästhesien, Gleichgewichtsstörungen, Geschmacksstörungen, Sehstörungen, Tinnitus, Hypotonie, Tachykardien, Palpitationen, trockener Reizhusten, Übelkeit, Bauchschmerzen, Erbrechen, Durchfall, Verstopfung, Exanthem, Pruritus, Somnolenz, Ödeme, Rötung im Gesicht; Urtikaria, vorübergehender Anstieg der Harnstoff- und Kreatininkonzentration im Blut, insbesondere bei Patienten mit Niereninsuffi zienz, schwerer Herzinsuffi zienz oder renovaskulärem Bluthochdruck, Insomnie, veränderte Stimmung, Tremor, Synkope, Hypoaesthesie, Dyspnoe, Rhinitis, Dyspepsie, trockener Mund, Alopezie, Purpura, Hautverfärbung, verstärktes Schwitzen, Rash, Photosensibilisierung, Arthralgie, Myalgie, Muskelkrampf, Rückenschmerzen, Miktionsstörungen, Impotenz, Gynäkomastie, Schmerz, Unwohlsein, Gewichtszunahme, Gewichtsabnahme. P: Tabletten in Pillendose zu 5 mg/5 mg, 5 mg/10 mg, 10 mg/5 mg und 10 mg/10 mg; 30 und 90 Tabletten, kassenzulässig, Liste B. Weitere Angaben: Siehe http://www.swissmedicinfo.ch/ Servier (Suisse) S.A., 1242 Satigny.

Starke Wirkung: der Patienten sind kontrolliert1

Signifi kante Reduktion der kardiovaskulären Mortalität: -24%2

Verbesserte Toleranz: -58% Ödeme1

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1. Hatala R. Optimization of Blood Pressure Treatment with Fixed-Combination Perindopril/Amlodipine in Patients with Arterial Hypertension, Clin Drug Investig 2012; 32 (9): 603-612. 2. Dahlöf B et al. for the ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial Lancet 2005;366:895-906.

Lacdigest® Kautabletten

Z: Tilactasum 60 mg (corresp. 2250 U.I), Kautabletten. I: Substitutionstherapie bei primärem und congenitalem Lactasemangelmit Auftreten von Symptomen wie Bauch-schmerzen, Flatulenz, Blähungen und Durchfallnach Einnahme von lactose haltiger Nahrung(Lactoseintoleranz). D: Im Allgemeinen 1 Kau-tablette pro 5 g Laktose. Maximale Einzeldosis:6 Kautabletten. Maximale Tagesdosis: 12 Kau-tabletten. KI: Überempfindlichkeit gegen Wirk-stoff oder einen der Hilfsstoffe. VM: Keine Erfahrungen bei Kindern unter 3 Jahren, keineDaten über Risikopopulationen. UW: Keine beobachtet. IA: Natrium- und Kaliumionenkönnen in vitro die Aktivität von Tilactase erhöhen. Calcium ionen und Schwermetalle wie Kupfer können in vitro die enzymatischeAktivität hemmen. P: Lacdigest 50 und 100Kautabletten. Abgabekategorie C. Kassen -zulässig. Ausführliche Informationen siehewww.swissmedicinfo.ch

1. Lacdigest (Tilactase): aktuelle SchweizerFachinformation auf www.swissmedicinfo.ch2. Portincasa P et al. Beneficial effects of oraltilactase on patients with hypolactasia. Eur JClin Invest. 2008;38(11):835-44.

Zulassungsinhaberin:Pro Farma AG, Lindenstrasse 12CH-6340 Baar, www.profarma.ch

Lacdigest.

Bei Laktose-intoleranz.1,2

KautablettenKassenzulässig

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Pro Farma AG ist Kooperationspartner von aha! Allergiezentrum Schweiz

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