Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jul 2011
ReviewMinimizing cardiac risk in perioperative practice - interdisciplinary pharmacological approaches.
In an aging population, major surgery is often performed in patients with complex co-morbidities. These patients present new risk constellations so that cardiac and respiratory complications mainly contribute to perioperative morbidity. ⋯ All the concepts described require an interdisciplinary approach in collaboration between operative physicians and physicians working in non-surgical disciplines like internal medicine, cardiology, and clinical pharmacology. The perioperative continuation of a pre-existing therapy with beta-blockers and other potentially cardioprotective agents like α(2)-agonists and statines is recommended. In the management of patients presenting for major surgery stratification of the perioperative risk is essential which considers both, invasiveness of the surgical procedure and conditions of the patient. Otherwise, side-effects might outweigh benefits of a potentially effective therapy as recently shown for the perioperative administration of beta-blockers that should be restricted to high-risk patients.
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Wien. Klin. Wochenschr. · Jul 2011
Randomized Controlled Trial Multicenter StudyQuality of diabetes care in Austrian diabetic patients willing to participate in a DMP - at baseline.
Diabetes mellitus type 2 plays an important role in population health worldwide, and diabetes care has been shown to be insufficient. Disease management programmes (DMPs) have been designed to overcome these deficiencies, but data on their effectiveness are inconclusive. One reason for the inconsistent extent of effects may be selection bias. Voluntary programmes might recruit preferably highly motivated patients who are already quite successful in managing diabetes. Other programmes enrol primarily patients with poor metabolic control which may lead to the demonstration of fairly large effects due to regression to the mean. We therefore investigated the baseline characteristics of patients willing to enrol in the Austrian DMP for diabetes mellitus type 2 ("Therapie aktiv"), and their quality of care. ⋯ Our results indicate that the majority of the patients receive treatment in adherence to current guidelines. Nevertheless there are deficits in care and hence room for improvement by implementation of the DMP.
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Wien. Klin. Wochenschr. · Jul 2011
Aneurysmatic subarachnoidal haemorrhage: incidence and location of small ruptured cerebral aneurysms - a retrospective population-based study.
The purpose of this retrospective population-based study was to investigate the incidence of subarachnoid haemorrhage from small (5 mm and below) cerebral aneurysms and their localisation in consecutive patients surgically treated in the State of Vorarlberg/Austria. ⋯ In conclusion, in our consecutive patient series with clipped cerebral aneurysms after subarachnoid haemorrhage, one third had small ruptured aneurysms, with the anterior cerebral artery complex as the main predilection site. Therefore, despite the previously reported low rupture risk, incidental small aneurysms should also be considered for therapy, depending on localisation and individual risk factors.
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Wien. Klin. Wochenschr. · May 2011
Case ReportsCan a giant cervical osteophyte cause dysphagia and airway obstruction? A case report.
Cervical spondylosis is a common disorder mainly affecting elderly people. It frequently presents with excessive bone formation (osteophytes). These may lead to pain and neurological deficits due to root compression. ⋯ We present the case of an 81-year-old patient suffering from dysphagia and slight dyspnoea due to a giant cervical osteophyte. Osteophyte resection was performed and the patient was relieved from symptoms. This case highlights that a large cervical osteophyte may, albeit rarely, be the cause of simultaneously presenting dysphagia and dyspnoea, and should, therefore, be included in the diagnostic workup in such cases.
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Wien. Klin. Wochenschr. · May 2011
Comparative StudyBone graft harvesting using the RIA (reaming irrigation aspirator) system - a quantitative assessment.
Autologous bone graft is still considered to be the gold standard for treating non-unions in trauma and orthopedic surgery. Intramedullary bone graft harvest appears to be an alternative to other bone graft options such as iliac crest bone graft and synthetic bone substitutes. A one-step reamer-irrigator-aspirator (RIA) system has been developed to reduce the intramedullary pressure and, as a consequence, minimize the risk of fat embolization. The purpose of this study was to determine whether the quantity of harvested intramedullary bone graft is comparable to the quantity of graft that was harvested from the iliac crest in other studies. The aim of the present study was to quantify harvested bone marrow and to compare our results to already published data. ⋯ On the basis of our present results, harvesting intramedullary bone graft with the RIA system appears to be an innovative technique for bone grafting in limb reconstruction. A significantly greater quantity of bone graft was harvested from the femora than the tibiae (p = 0.007). No significant differences among age, sex, body weight, bone length, or BMI were observed. Our results showed that a sufficient quantity in weight of autogenous bone graft could be obtained using the RIA system.