M Solèr

University Hospital of Lausanne, Lausanne, VD, Switzerland

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Publications (67)261.13 Total impact

  • M. Solèr · E. Imhof · A.P. Perruchoud ·
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    ABSTRACT: Bronchial asthma is characterized as a disease with recurrent, reversible, and generalized airway obstruction and an increased airway responsiveness to nonspecific stimuli. Besides symptoms of airway hyperresponsiveness, episodic asthmatic attacks, and chronic airway obstruction, severe acute asthma, or ‘status asthmaticus’, is an important and life-threatening manifestation of the disease. This paper gives an overview of the pathophysiology, clinical risk assessment, and treatment of severe acute asthma
    Respiration 07/2004; 57(2):114-121. DOI:10.1159/000195831 · 2.59 Impact Factor
  • Andreas H Diacon · Martin H Brutsche · Markus Solèr ·
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    ABSTRACT: To assess the value of chest ultrasonography vs clinical examination for planning of diagnostic pleurocentesis (DPC). Prospective comparative study. Pulmonary unit of a tertiary teaching hospital. Patients and participants: Sixty-seven consecutive patients referred to 30 physicians of varying degrees of experience for DPC. Based on clinical data and examination, physicians determined whether and where a DPC should be performed. Selected puncture sites were evaluated with ultrasound and considered accurate when > or = 10 mm fluid perpendicular to the skin were present. Measurements and results: In 172 of 255 cases (67%), a puncture site was proposed. Twenty-five sites (15%) were found to be inaccurate on ultrasound examination, and a different, accurate site was established in 20 of these cases. Physicians were unable to locate a puncture site in 83 cases (33%). Among these, ultrasound demonstrated an accurate site in 45 cases (54%), while a safe tap was truly impossible in 38 cases (46%). Overall, ultrasound prevented possible accidental organ puncture in 10% of all cases and increased the rate of accurate sites by 26%. The sensitivity and specificity for identifying a proper puncture site with clinical examination compared to ultrasound as the "gold standard" were 76.6% and 60.3% (positive and negative predictive values, 85.5% and 45.8%, respectively). Risk factors associated with inaccurate clinical site selection were as follows: small effusion (p < 0.001), evidence of fluid loculation on chest radiography (p = 0.01; relative risk, 7.8; 95% confidence interval, 1.9 to 32.9), and sharp costodiaphragmatic angle on chest radiography (p < 0.001; relative risk, 7.0; 95% confidence interval, 2.3 to 15.2). Experienced physicians did not perform better than physicians in training. Puncture site selection with bedside ultrasonography increases the yield of and potentially reduces complication rate in DPC. Physician experience does not predict the accuracy of selected puncture sites.
    Chest 02/2003; 123(2):436-41. DOI:10.1378/chest.123.2.436 · 7.48 Impact Factor
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    ABSTRACT: Outpatient CT-guided radiofrequency ablation (RFA) of a pulmonary metastasis followed by surgical resection and histopathological analysis was performed in a 72-year-old lady suffering from a peritoneal leiomyosarcoma. Histological workup 3 weeks post-ablation showed complete devitalization of the metastasis. This case report demonstrates that complete thermal destruction of a pulmonary metastasis by percutaneous image-guided RFA is possible.
    CardioVascular and Interventional Radiology 12/2002; 25(6):543-6. DOI:10.1007/s00270-002-2646-x · 2.07 Impact Factor
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    ABSTRACT: Even though complete resection is regarded as the only curative treatment for nonsmall cell lung cancer (NSCLC), >50% of resected patients die from a recurrence or a second primary tumour of the lung within 5 yrs. It remains unclear, whether follow-up in these patients is cost-effective and whether it can improve the outcome due to early detection of recurrent tumour. The benefit of regular follow-up in a consecutive series of 563 patients, who had undergone potentially curative resection for NSCLC at the University Hospital, was analysed. The follow-up consisted of clinical visits and chest radiography according to a standard protocol for up to 10 yrs. Survival rates were estimated using the Kaplan-Meier analysis method and the cost-effectiveness of the follow-up programme was assessed. A total of 23 patients (6.4% of the group with lobectomy) underwent further operation with curative intent for a second pulmonary malignancy. The regular follow-up over a 10-yr period provided the chance for a second curative treatment to 3.8% of all patients. The calculated costs per life-yr gained were 90,000 Swiss Francs. The cost-effectiveness of the follow-up protocol was far above those of comparable large-scale surveillance programmes. Based on these data, the intensity and duration of the follow-up was reduced.
    European Respiratory Journal 03/2002; 19(3):464-8. DOI:10.1183/09031936.02.00231802 · 7.64 Impact Factor
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    ABSTRACT: We prospectively compared five techniques to estimate predicted postoperative function (ppo F) after lung resection: recently proposed quantitative CT scans (CT), perfusion scans (Q), and three anatomical formulae based on the number of segments (S), functional segments (FS), and subsegments (SS) to be removed. Four parameters were assessed: FEV(1), FVC, DL(CO) and VO(2max), measured preoperatively and 6 months postoperatively in 44 patients undergoing pulmonary resection, comparing their ppo value to the postoperatively measured value. The correlations (r) obtained with the five methods were for CT: FEV(1) = 0.91, FVC = 0.86, DL(CO) = 0.84, VO(2max) = 0.77; for Q: 0.92, 0.90, 0.85, 0.85; for S: 0.88, 0.86, 0.84, 0.75; for FS: 0.88, 0.85, 0.85, 0.75, and for SS: 0.88, 0.86, 0.85, 0.75, respectively. The mean difference between ppo values and postoperatively measured values was smallest for Q estimates and largest for anatomical estimates using S. Stratification of the extent of resection into lobectomy (n = 30) + wedge resections (n = 4) versus pneumonectomy (n = 10) resulted in persistently high correlations for Q and CT estimates, whereas all anatomical correlations were lower after pneumonectomy. We conclude that both Q- and CT-based predictions of postoperative cardiopulmonary function are useful irrespective of the extent of resection, but Q-based results were the most accurate. Anatomically based calculations of ppo F using FS or SS should be reserved for resections not exceeding one lobe.
    Respiration 02/2002; 69(6):482-9. DOI:10.1159/000066474 · 2.59 Impact Factor
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    E Ullmer · H Borer · P Sandoz · M Mayr · P Dalquen · M Soler ·

    Radiologia Brasileira 01/2002; DOI:10.1590/S0100-39842002000200018
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    ABSTRACT: We report on a 17-year-old patient with severe bronchiolitis due to Mycoplasma pneumoniae infection. Despite an early 10-day course of clarithromycin, she developed progressive dyspnea, cough, fever, and severe obstructive ventilatory impairment. Sixteen days after onset of the disease a severe hemolytic anemia developed with only cold agglutinins positive at serologic screening. Thoracoscopic lung biopsy revealed diffuse bronchiolitis with suppurative intrabronchiolar inflammation, lymphohistiocytic "cuffing" of the bronchioli, and foam cell aggregates within neighboring alveoli. The infiltrate consisted mainly of CD3+, CD8+ lymphocytes and CD68+ macrophages. The diagnosis of Mycoplasma pneumoniae bronchiolitis was based on repeated complement fixation tests, which turned strongly positive only at day 74 after onset of the disease. Pulmonary function improved slowly under long-term prednisone treatment.
    Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 01/2002; 439(6):818-22. DOI:10.1007/s004280100473 · 2.65 Impact Factor
  • E Ullmer · H Borer · P Sandoz · M Mayr · P Dalquen · M Solèr ·

    Chest 11/2001; 120(4):1394-8. · 7.48 Impact Factor
  • M Tamm · P Traenkle · B Grilli · M Solèr · C T Bolliger · P Dalquen · G Cathomas ·
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    ABSTRACT: Cytomegalovirus (CMV) infection and CMV disease are frequent complications in immunocompromised patients. In this study, the incidence of pulmonary CMV infection was analyzed in different groups of immunocompromised patients and the diagnostic value of immunostaining with anti-CMV antibodies in BAL cells was evaluated in regard to the diagnosis of CMV pneumonitis. Five hundred eighty consecutive BAL procedures were analyzed prospectively in 442 immunocompromised and 126 nonimmunocompromised control subjects. CMV culture in BAL fluid was performed by shell vial assay and immunostaining using three monoclonal anti-CMV antibodies. The incidence of culture results positive for CMV in the BAL fluid varied from 20 to 30% in HIV-positive patients, in patients following stem cell or renal transplantation, and in patients with autoimmune disease or lung fibrosis treated with immunosuppressive agents. CMV was cultured from 4.4% of BALs in patients treated with high-dose chemotherapy and from 2.4% of control subjects. CMV disease developed in 37 patients; in 18 of these patients, CMV pneumonitis was present. The results of CMV immunostaining were positive in a total of 22 BALs, all in patients with CMV disease. The sensitivity, specificity, and positive and negative predictive values of positive CMV immunostaining results for the diagnosis of CMV pneumonitis were 88.9%, 98.6%, 72.7%, and 99.5%, respectively. The incidence of pulmonary CMV infection is similar in different groups of immunocompromised patients except for patients following high-dose chemotherapy. CMV immunostaining in the BAL fluid is a very helpful method to diagnose CMV pneumonitis in these patients.
    Chest 04/2001; 119(3):838-43. DOI:10.1378/chest.119.3.838 · 7.48 Impact Factor
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    ABSTRACT: The worldwide increase in asthma incidences and the impact of the disease on public health care have led to new investigations of the cause of the disease. Besides well-defined environmental causes, accumulating evidence suggests that respiratory tract infections play an important role in the pathogenesis of asthma. Among these microorganisms Chlamydia pneumoniae is an intracellular pathogen causing persistent infection. Chlamydia pneumoniae infection has been discussed as possibly inducing the development of asthma. This study was designed to investigate the presence of C. pneumoniae-specific IgG, IgA, and IgM antibodies in serum samples of 33 adults with a clinical history of asthma, positive methacholine test, and reduced FEV(1). Patients with asthma were compared with age-, sex-, and locality-matched control subjects (n = 33). We observed no acute infection either in patients with asthma or in control subjects, but 63% of all investigated individuals had signs of past infection. Chlamydia pneumoniae-specific IgA was detected in 52% of the patients with asthma and in 15% of the healthy control subjects (p < 0.01). Serological evidence of chronic infection with C. pneumoniae (high IgG [> pr = 1:512] and high IgA [> or = 1:40]) was more frequent in patients with asthma (18.2%) compared with control subjects (3.0%) (p < 0.01). Our results provide further evidence that chronic infection with C. pneumoniae is linked to asthma.
    American Journal of Respiratory and Critical Care Medicine 04/2001; 163(5):1097-100. DOI:10.1164/ajrccm.163.5.2003162 · 13.00 Impact Factor
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    ABSTRACT: Organ transplant recipients are at high risk of infectious pulmonary complications. In this retrospective study, the diagnostic yield of bronchoalveolar lavage (BAL) was evaluated in renal transplant recipients. The results were analysed in special regard to the clinical presentation of pulmonary infections and the possible impact of new immunosuppressive agents. Over a 5-year period 91 BAL were performed in 71 renal transplant recipients. Microorganisms were isolated from 69% of BAL (63/91): bacteria 32%; cytomegalovirus (CMV) 27%; Pneumocystis carinii (PC) 22%; other viruses 9% (HSV; EBV, RSV, adenovirus, HHV8); Aspergillus fumigatus 1%. Total cell counts and neutrophil counts in BAL were significantly elevated in bacterial infection, whereas BAL positive for PC showed eosinophilia (P<0.05). There was no association between clinical symptoms and the radiological pattern of infiltrates and the type of infection. Immunosuppression containing tacrolimus or mycophenolate mofetil was associated with a significantly higher percentage of PC and CMV infections compared to cyclosporin-based immunosuppression (65% vs. 30%, P<0.005). A considerable number of PC and CMV infections occurred beyond 6 months after transplantation. In conclusion, BAL has a high diagnostic yield in renal transplant recipients. Infection with CMV and PC should also be considered beyond 6 months after transplantation, and prophylaxis for opportunistic infections should be given if the immunosuppression is intensified.
    Transplant Infectious Disease 03/2001; 3(1):2-7. DOI:10.1034/j.1399-3062.2001.003001002.x · 2.06 Impact Factor
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    ABSTRACT: Induction of pleurodesis offers benefit for patients with metastatic tumors and symptomatic malignant pleural effusions, but the best method for achieving this is still unknown. In this prospective, randomized comparison of two well-established pleurodesis procedures, 36 patients with malignant pleural effusions, expanded lungs after drainage, and expected survival of > 1 mo received either bleomycin instillation (60E) via a small-bore thoracostomy tube or thoracoscopic talc poudrage (5 g) under local anesthesia. Efficacy, safety, and cost could be evaluated for 32 treatments (17 bleomycin, 15 talc) in 31 patients. Recurrence rates of effusion with bleomycin and talc poudrage after 30 d were 41% and 13% (p = 0.12), respectively, those after 90 d were 59% and 13%, respectively (p = 0.01), and those after 180 d were 65% and 13% (p = 0.005), respectively. Neither procedure showed any major adverse effect, and both were equally well tolerated. Cost estimation favored thoracoscopic talc poudrage, both for the initial hospitalization and with regard to recurrences. In conclusion, thoracoscopic talc pleurodesis under local anesthesia is superior to bleomycin instillation for pleurodesis in cases of malignant pleural effusion.
    American Journal of Respiratory and Critical Care Medicine 11/2000; 162(4 Pt 1):1445-9. DOI:10.1164/ajrccm.162.4.2002030 · 13.00 Impact Factor
  • Hartmut Schächinger · Michael Grob · Rudolf Ritz · Markus Soler ·
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    ABSTRACT: Little is known about mental stress effects on the pulmonary circulation in health and disease. The current study was conducted to investigate whether pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) would further increase during standardized mental stress testing in patients with severe pulmonary hypertension. The study was a prospective analysis of seven patients (average age: 40 years, range from 21 to 56 years) with severe pulmonary hypertension (primary: n = 4, secondary forms: n = 3; resting mean pulmonary artery pressure ranged between 48 and 65 mmHg). Right heart catheterization for the determination of PAP, pulmonary capillary wedge pressure (PCW) and cardiac output (CO) was clinically indicated (diagnostic workup, acute drug testing). Patients accomplished a standardized 10 min mental stress test (computer based, adaptive complex reaction-time task). Pulmonary haemodynamics during stress were compared to resting baseline. During mental stress mean PAP (+/- SEM) increased by 9.4 +/- 2.1 mmHg (P < 0.005). Pulmonary vascular resistance increased by 149 +/- 25 dyne s cm-5 (P < 0.001). Stroke volume decreased by 6.6 +/- 2.2 ml (P < 0.03). The data show that moderate mental stress increases right heart afterload in patients with severe pulmonary hypertension owing to elevation of PVR.
    Clinical Physiology 11/2000; 20(6):483-7. DOI:10.1046/j.1365-2281.2000.00287.x
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    ABSTRACT: Sixty-one consecutive patients with locally advanced inoperable non-small-cell lung cancer were treated with chemoradiation with 60 Gy and concomitant daily low-dose cisplatin (6 mg/m(2)) in a single uninterrupted course. Toxicity was mild, 80% of patients were treated as outpatients. The median survival of 70 weeks compares favorably to the literature.
    Radiotherapy and Oncology 09/2000; 56(2):169-73. DOI:10.1016/S0167-8140(00)00203-6 · 4.36 Impact Factor
  • E Ullmer · M Solèr ·
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    ABSTRACT: About 40% of adults are habitual snorers. 2% of women and 4% of men between 30 and 60 years of age present additional sleep disordered breathing. There is a continuous spectrum from simple to disease-causing snoring ranging from merely disturbing noises to pharyngeal obstructions and breathing pauses. Repetitive episodes of upper airway obstructions lead to frequent arousals from sleep. Sleep fragmentation is responsible for non-refreshing sleep and subsequent excessive daytime sleepiness resulting in reduced performance at work, social problems and a higher risk for accidents. Furthermore there is a correlation between arousals and cardiovascular abnormalities. Anatomic narrowing of the upper airway or hypotonia of the orpharyngeal dilator muscles favour collapse of the oropharyngeal walls. Obstructive sleep apnea syndrome is characterized by repetitive oxyhemoglobin desaturations during sleep recorded by pulseoximetry. Polygraphy quantifies the average number of apneas and hypopneas which occur during one hour of sleep (apnea-hypopnea index = AHI). In upper airway resistance syndrome (= UARS), upper airway resistance is increased, but pharyngeal obstruction is not complete. Saturation doesn't decrease significantly, but arousals with consecutive sleep disruption still occur. Polysomnography is a comprehensive study including EEG-, EOG- and EMG-recordings. Sleep stages and events can be scored to evaluate sleep architecture, sleep efficiency and sleep fragmentation.
    Therapeutische Umschau 08/2000; 57(7):430-4.
  • E. Ullmer · M. Solèr ·

    Therapeutische Umschau 07/2000; 057(07):0430-0434. DOI:10.1024/0040-5930.57.7.430
  • M.H. Brutsche · A. Diacon · A. Droll · P. Dalquen · M. Solèr ·

    Respiration 07/2000; 67(4):444-444. DOI:10.1159/000029545 · 2.59 Impact Factor
  • E Ullmer · M Solèr · H Hamm · A P Perruchoud ·

    Pneumologie 04/2000; 54(3):123-32. DOI:10.1055/s-2000-9079
  • M H Brutsche · A Diacon · A Droll · P Dalquen · M Solèr ·

    Respiration 02/2000; 67(4):444. · 2.59 Impact Factor
  • E Ullmer · W M Strobel · M Solèr ·

    Respiration 02/2000; 67(2):203. DOI:10.1159/000029487 · 2.59 Impact Factor

Publication Stats

2k Citations
261.13 Total Impact Points


  • 2004
    • University Hospital of Lausanne
      • Département de médecine
      Lausanne, VD, Switzerland
  • 1989-2003
    • Universitätsspital Basel
      • Klinik für Infektiologie & Spitalhygiene
      Bâle, Basel-City, Switzerland
  • 2002
    • Universität Basel
      • Institut für Pathologie
      Bâle, Basel-City, Switzerland