Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Oct 2002
Case Reports Comparative StudyManagement of respiratory deterioration in a pregnant patient with severe kyphoscoliosis by non-invasive positive pressure ventilation.
The problem of kyphoscoliosis in combination with pregnancy is uncommon and published cases are rare. Until now, little and controversial information on the outcome, optimal management and course of pregnancy in patients with kyphoscoliosis has been available. The majority of maternal deaths seem to be attributed to cardiorespiratory failure, while obstetric complications account for relatively few complications. ⋯ Home nocturnal ventilatory support was continued as nocturnal episodic desaturations were also assessed during the postpartum period. At time of discharge, the patient's exercise capacity and lung function were nearly equal to levels before pregnancy. We conclude that pregnancy in selected kyphoscoliotic patients with severe limitations in lung function is relatively safe for both the mother and the child when NIPPV is used for overcoming respiratory deterioration and for preventing further cardiorespiratory failure.
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Wien. Klin. Wochenschr. · Oct 2002
Comparative StudyEndothelial cell activation and blood coagulation in critically ill patients with lung injury.
Adult respiratory distress syndrome is a life-threatening disease that requires respiratory assistance. It is associated with endothelial cell damage, coagulation activation, and intravascular fibrin deposition. This prospective study was conducted to determine whether the plasma levels of specific markers of endothelial cell function and coagulation activation are related to the degree of pulmonary disturbance. ⋯ These findings suggest that the endothelial cell disturbance and the activation of the coagulation system in patients with lung injury are related to the degree of pulmonary dysfunction.
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Wien. Klin. Wochenschr. · Oct 2002
Comparative Study[Adaptation of guidelines for the treatment of chronic heart failure in a specialized heart failure clinic].
Chronic heart failure is associated with high mortality and morbidity. In spite of a number of trials showing significant improvement in survival and reduction in hospitalization for patients who received ACE inhibitors/AT1 receptor antagonists (ACEI/ARB), beta-blockers and spironolactone, and notwithstanding the recommendations of national and international guidelines for the management of heart failure, substantial proportions of patients are not receiving this treatment. The aim of our study was to analyse 1. the efficiency of a specialized heart failure clinic in translating guidelines into clinical practice, and 2. the effect of optimized neurohormonal therapy on patient outcome. ⋯ Guidelines for the management of chronic heart failure patients can be translated efficiently into clinical practice by a specialized heart failure clinic. Optimization of therapy is associated with an improvement in functional status and a decrease in mortality or hospitalization for worsening heart failure. Therefore the nationwide installation of specialized heart failure clinics is required.