Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Apr 2000
Review[Pain management in view of current new legislative updates and their practical consequences in Austria].
Although the WHO edited guidelines for pain treatment as early as 1986, practical management has frequently remained inadequate, especially in cancer patients. Traditional adherence to restrictions from the former Austrian Controlled Drug Act which have resulted in ongoing limitations in the prescription of opioids as well as complicated formal regulations in the current law represent two major obstacles. As a consequence, recent legislation of a "state of the art" pain management in Austria facilitates adequate provision of analgesics on the one hand, and may, on the other, even result in claims for indemnity should these be withhold.
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Wien. Klin. Wochenschr. · Apr 2000
Review[Cortisol in critically ill patients with sepsis: physiologic functions and therapeutic implications].
Modern immunology reveals that cortisol interacts with the immune response at virtually all levels exerting both suppressive and permissive effects. A pre-requisite for the defense against severe infections is the functional integrity of the hypothalamic-pituitary-adrenal axis (HPAA) resulting in adequate cortisol production. There is increasing evidence that cortisol physiology and regulation are substantially altered in the course of a septic shock. ⋯ Large-scale trials are on the way investigating the benefit of stress doses of hydrocortisone on the mortality of septic shock. The focus of this review are changes in glucocorticoid physiology and regulation during septic shock. Effects of stress doses of hydrocortisone on immune response and vascular tone in the course of a septic shock are being discussed.
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Wien. Klin. Wochenschr. · Apr 2000
Clinical TrialIntra- and interindividual reproducibility of heart rate variations in the tilt-table test.
Various methods are used for the routine diagnosis of autonomic regulation disorders. The evaluation of blood pressure and heart rate response during active orthostasis together with assessment of the 30/15-ratio (Ewing's ratio) was proven to be a valid method. One main disadvantage of these tests is their dependence on the active cooperation of the patient. ⋯ However, all subjects showed considerable variations in heart rate response within the 10 tilting manoeuvres. A reliable quotient comparable with the 30/15 ratio (Ewing's ratio) in active orthostasis was not seen. Based on these results, we conclude that the initial heart rate response in the tilt-table test is not suitable for routine diagnosis of autonomic regulation disorders, since it is not sufficiently reproducible in healthy individuals.