Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jun 2000
Case ReportsContinuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II).
A 60-year-old man was admitted to the hospital with aortic dissection. An operative excision and replacement with a Y-graft was performed. Postoperatively he developed multiple organ dysfunction and required intermittent haemofiltration (anticoagulation with heparin). ⋯ In partly permeable polysulfon filters a dose of 0.005 mg/kg bw/h lepirudin is sufficient to maintain adequate anticoagulation. Monitoring anticoagulation by measuring the increase of aPTT (factor 1.5-2.0) seems to be safe. However, optimally the r-hirudin concentration should be measured directly using the Ecarin clotting time.
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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.