Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Sep 1998
[Prevalence and follow-up of psychiatric diseases in internal medicine departments].
While several surveys have shown that psychiatric disorders are common in non-psychiatric hospital departments, information on the course of psychiatric morbidity during the hospital stay is still lacking. Therefore, in two medical hospital departments in Austria we investigated the course of illness in 265 patients staying in the hospital for more than four weeks. Patients were interviewed using the Clinical Interview Schedule. ⋯ At both assessments, organic mental illness was the most frequent diagnosis followed by neurotic and adjustment disorders. Thus, in spite of the slightly higher rate of remission than incidence, the overall psychiatric prevalence increased during the first four weeks after admission because of the earlier discharges of the mentally well. In conclusion, our results show that point-prevalence surveys not regarding disease course give an incomplete impression of psychiatric morbidity in non-psychiatric hospital departments.
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Based on the changing disease pattern of human immunodeficiency virus (HIV) associated pulmonary complications we conducted a prospective study in order to compare the value of laboratory tests in patients with Pneumocystis (P.) carinii pneumonia (PCP) and other pulmonary complications and of different identification methods of P. carinii in bronchoalveolar lavage fluid (BALF) in PCP patients. ⋯ A detection of P. carinii in BALF is inevitable for a definitive diagnosis of a PCP. The most efficient identification method in this case is the MGG stain. Platelets, total serum protein, and CD4+ T-lymphocyte count should be included into the criteria for the presumptive diagnosis of PCP.
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Acute hepatic failure is characterized by jaundice and hepatic encephalopathy within eight weeks after the onset of disease. Although acute hepatic failure is a rare occurrence, its rapid progression and high mortality (50 to 90%, depending on the etiology of disease) necessitate immediate intervention. In the absence of causal therapy, orthotopic liver transplantation is currently the only definitive and effective means of treating acute hepatic failure in Europe, acute hepatic failure accounts for 11% of all liver transplantations. ⋯ With a 3-year graft survival rate of 70% the 3-year patient survival rate was 74%. A retrospective analysis of our patients revealed that the postoperative graft function and the incidence of re-transplantation were significant prognostic factors (p < 0.05) for survival following orthotopic liver transplantation for acute hepatic failure. In the absence of further prognostically relevant preoperative indices and in consideration of the potentially fulminant progression of disease, we strongly recommend that any patient, in whom acute hepatic failure is suspected, is immediately transferred to a specialized center with experience both in the conservative treatment of acute hepatic failure and emergency liver transplantation.