Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1995
[Flexible fiberoptic bronchoscopy in pediatrics--an analysis of 420 examinations].
Over a 4-year period we performed 420 endoscopic investigations in 262 patients (aged 1 day-26 yrs) under sedation and local anesthesia, using several different flexible instruments; repeat procedures were performed in 58 children. The most common indications for diagnostic endoscopy were tracheostomy evaluation (27.1%), non-specific chest x-ray changes (13.8%), stridor (12.4%), atelectasis (7.9%), and the sampling of airway secretions or cells by bronchoalveolar lavage (5.5%); indications for 17 therapeutic endoscopies (4%) included the removal of airway secretions and mucus plugs, and aid in difficult intubations. Bronchomalacia (46X), tracheomalacia (41X), obstructing granulation tissue (36X), and laryngomalacia (35X) were the most common diagnoses; in addition, subglottic stenosis was found in 13, a subglottic hemangioma in 5, vocal cord paralysis in 5 and an endobronchial foreign body in 5 children. ⋯ The success rate of therapeutic procedures was 70.6%. Minor complications occurred in altogether 4.3% of cases; all were completely and rapidly reversible. Flexible fiberoptic bronchoscopy is a safe and valuable diagnostic and therapeutic tool for the management of infants and children with respiratory problems.
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Wien. Klin. Wochenschr. · Jan 1995
Case Reports[Acute respiratory failure (ARDS) in a young child after drowning accident: therapy with exogenous surfactant and high frequency oscillatory ventilation].
The adult respiratory distress syndrome (ARDS) in children has a very poor prognosis with a mortality risk of between 55 and 85%, in spite of improvements due to the introduction of positive endexpiratory pressure ventilation. We describe the clinical course of a not yet 3 year-old boy with severe ARDS following near-drowing. Treatment with exogenous surfactant and high frequency oscillatory ventilation, a well-established procedure in neonatology, was responsible for the favorable outcome. The high cost of surfactant therapy, however, is the main limiting factor for this kind of treatment in children beyond the neonatal period, but it may be the last therapeutic resort in the management of severe ARDS.
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Wien. Klin. Wochenschr. · Jan 1995
[Acute management of para-articular hip fractures in geriatric patients].
Coxal femoral fractures in the elderly present a growing problem due to the increasing life expectancy of the population. The most rapid intervention possible with an implant best tailored to the individual's needs and general medical condition, followed by early mobilisation and individual physiotherapeutic management are the basic prerequisites in the attempt to achieve a decrease in the post-operative complication rate, the mortality rate and spiraling costs. ⋯ Operation took place on average 14.2 hours after admission and the patients were discharged on average 15.6 days after hospitalisation. 37 of 620 (5.9%) patients operated on during the first 24 hours (group 1) and 9 of the 99 (9.1%) delayed operation patients (> 24 h = group 2) died in hospital. The findings are discussed in the light of the shortage of hospital beds, an aging population and rising hospital costs.
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Wien. Klin. Wochenschr. · Jan 1995
[Extracorporeal membrane oxygenation in newborn infants and children].
The purpose of this report is to describe our experience with veno-arterial (VA) and veno-venous extracorporeal membrane oxygenation (VV-ECMO) for neonates and children with severe acute respiratory or cardiocirculatory failure. From 1990 to 1994 20 neonates and 12 children were treated at the ECMO center in Graz. Indications for ECMO were acute respiratory failure in 27 patients and cardiocirculatory failure in 5 patients. ⋯ Major complications on ECMO were local and intracerebral bleeding. ECMO is an effective therapy for neonates and children with acute respiratory failure. It is less effective for cardiac support in children after open heart surgery, but the use of heparin-layered ECMO systems might increase the safety of the procedure.
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Wien. Klin. Wochenschr. · Jan 1995
[Medical informatics in research, teaching and patient management].
The field of medical informatics in its current understanding is defined and criteria distinguishing this field from similar areas are provided. Special consideration is given to its position at a School of Medicine - in particular to the University of Vienna Medical School with the Vienna General Hospital as its teaching hospital. ⋯ At many places these institutions are as follows: (1) a department or division of medical informatics with a possibly attached computer center dedicated to provide assistance in the area of research and teaching, (2) the computer center of the respective university the School of Medicine belongs to, (3) the computer center of the hospital-owned institution responsible for all EDP activities connected to patient care, and (4) external software companies and EDP training centers. To succeed in the development of an exhaustive, school-wide system of medical informatics and EDP that considers the different demands in research, teaching, and EDP hospital operations equally, close and well-suited coordination between the institutions involved is necessary.