Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1996
Review[The value of adjuvant and neoadjuvant chemotherapy in treatment of stomach carcinoma].
The incidence of gastric adenocarcinoma has decreased dramatically in most Western countries over the past five decades. However, the five-year survival rate remains poor and late diagnosis is one of the main reasons for the lack of marked improvement in outcome. More than 50% of the patients found to have advanced local (stage T III), or systemic (stage T IV) gastric cancer at the time of diagnosis. ⋯ The efficacy of neoadjuvant chemotherapy in potentially resectable gastric carcinoma cannot be definitely assessed at the present time since only scant, preliminary findings are available. Future goals for the treatment of gastric carcinoma should include studies evaluating preoperative chemotherapy using effective, but less toxic substances, based on exact tumor-staging by means of endoluminal sonography. Furthermore, research projects investigating the value of intraperitoneal therapeutic regimens such as hyperthermic chemoperfusion or intraperitoneal instillation of the requisite substances in the prevention of intraperitoneal carcinomatosis and local recurrence will be of great importance.
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Wien. Klin. Wochenschr. · Jan 1996
[Predictive value of score parameters of the Simplified Acute Physiology Score (SAPS)-II for the duration of treatment of intensive care patients].
Length of intensive care therapy and the total length of stay in hospital are important determinants of hospital costs. We therefore analysed the correlation between score parameters of SAPS-II with the time spent in the intensive care unit (ICU), and also in the hospital, for 604 general medical intensive care patients (ICU group) and 510 coronary care patients (CCU group). The mean stay in the ICU was 3.68 days for ICU patients and 2.67 days for CCU patients. ⋯ In ICU patients duration of intensive treatment and hospital stay correlated with age, heart rate, maximum systolic blood pressure, body temperature, BUN, serum bilirubin, and sodium (all signs of systemic inflammatory reaction and organ dysfunction); in CCU patients length of intensive treatment and hospital stay correlated with body temperature, diuresis, BUN, bicarbonate, minimum systolic blood pressure (as signs of organ perfusion). A low Glasgow Coma Score was correlated with prolonged intensive care in all patients. In conclusion, score data, appear a suitable tool to predict the duration of intensive care treatment and length of hospitalization, in addition to outcome, and thus serve as gauge of efficiency.
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Wien. Klin. Wochenschr. · Jan 1996
Intensive care management of acute pancreatitis: recognition of patients at high risk of developing severe or fatal complications.
The clinical spectrum of acute pancreatitis ranges from mild, self-limiting disease of fulminant illness that may rapidly lead to multiple organ failure and death. To identify factors associated with a subsequent severe course and/or high mortality we investigated retrospectively 91 patients admitted to the medical intensive care unit (ICU) with acute pancreatitis during a 2 year period. 67% of the attacks were mild (< or = 1 complication). The overall mortality rate was 9%, whereby 3% of patients with alcoholic and 13% with biliary pancreatitis died. 75% of the patients in the group with a fatal outcome were aged over sixty and 30% in the group with a mild course (p < 0.05). ⋯ The RANSON scoring system provided further a significant differentiation between survivors with a severe course of pancreatitis when compared to deaths on day 2, whereas the APACHE-III scoring system did not. Advanced age, female sex, biliary obstruction and elevated RANSON and APACHE-III scores are risk factors for an increased rate of life-threatening complications in acute pancreatitis. The daily assessment of such scoring systems may allow the recognition of such patients and may be helpful in the routine clinical management and monitoring of acute pancreatitis.
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During the past years perinatal mortality in diabetic pregnancy has been lowered significantly, in special collections with highly motivated diabetic women even below 2%. In case of optimal metabolic control and absence of diabetic angiopathy the perinatal survival rate is identical to that in normal pregnancy. But adequate metabolic control cannot be reached in all pregnant women during the whole period of gestation, and pre-existing diabetic angiopathy exists frequently; therefore diabetic pregnancy will be associated with elevated perinatal mortality and morbidity also in the future. ⋯ Diabetic women with macroangiopathy, especially with coronary artery disease show a high risk for cardiovascular events during pregnancy. The occurrence of acute myocardial infarction in pregnant diabetic women is associated with elevated fetal and maternal mortality. Though there are case reports in the literature describing a successful fetal and maternal outcome after myocardial infarction during pregnancy.
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Wien. Klin. Wochenschr. · Jan 1996
Comparative Study[Evaluation of a new method for determining glycated hemoglobin with monoclonal antibodies (DCA 2000)].
HPLC (High Performance Liquid Chromatography) is commonly regarded as the reference method for HbAlc measurements. However, HPLC requires a relatively large technical staff, expensive laboratory equipment and is rather time consuming. The mobile DCA 2000 instrument determines HbAlc in only 9 minutes, using only one microliter of capillary blood. ⋯ The maximum deviations were plus 1.6% and minus 1.3% HbAlc. DCA 2000 is easy to handle and gives rapid and reliable information on long-term metabolic control. Hence, it could be very useful for clinical practice and outpatient departments.