Wiener klinische Wochenschrift
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Acute rhabdomyolysis is a rare complication in patients with status asthmaticus receiving mechanical ventilation. Individual reports implicate several factors, whereby the simultaneous use of high-dose glucocorticoids and non-depolarizing muscle blocking agents appears to be the major patho-physiological mechanism. A 48 year-old female patient with a 3-year history of granulomatous vasculitis Churg-Strauss was admitted to the intensive care unit (ICU) due to severe status asthmaticus, which necessitated endotracheal intubation and mechanical ventilation. ⋯ Additionally, the patient was treated with non-depolarizing muscle blocking agents (atracurium 2070 mg over 7 days). Six days after admission to the ICU the patient developed severe rhabdomyolysis, with an increased creatine kinase (CK) level and myoglobinuria. The maximum CK value occurred 12 days after ICU admission (3810 U/l), accompanied by a serum myoglobin level of 13,900 ng/ml. 5 days after cessation of muscle relaxant therapy and reduction of intravenous glucocorticoids, the serum CK level decreased, reaching normal values 9 days later.
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Acute severe headache indicative of subarachnoid haemorrhage (SAH), but without the requisite proof, is defined as thunderclap. A special pathophysiological mechanism for the development of this headache is not known as yet. This retrospective study comprised 84 patients. ⋯ Thunderclap headache has no diagnostic or prognostic specificity and therefore we recommend use of this term only as a description of the headache characteristic. Thunderclap headache is not a predictor of a future SAH. Cerebral angiography should be restricted to cases with neurological deficits.
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Wien. Klin. Wochenschr. · Jan 1996
Biography Historical Article[Rudolf Ekstein's contributions to psychotherapy and child psychiatry].
Rudolf Eksteins scientific career is closely linked to his personal history, with his Jewish heritage, his political involvement and his social work with young people, which guided him towards psychoanalytic educational theory. Following his forced emigration to the USA in 1938 he became a world-famous child therapist, psychoanalyst, scientist and professor of medical psychology at the Department of Psychiatry, UCLA. The most significant areas of Eksteins extensive scientific output are described in an attempt to do justice to his contributions to psychotherapy and child psychiatry. ⋯ His underlying concept of schizophrenic psychosis and borderline personality disorders in children is outlined. Further, we have tried to show in what way his contributions to psychoanalytic theory and techniques were influenced by his profound knowledge of philosophy and linguistics. Finally Eksteins dedications to the teaching and learning of psychotherapy is stressed, from which a whole generation of Austrian psychiatrists, psychologists and pedagogues have profited enormously, as a result of his long-standing teaching commitments as guest professor at Vienna University.
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Wien. Klin. Wochenschr. · Jan 1996
[Intraventricular morphine administration as a treatment possibility for patients with intractable pain].
The treatment of intractable pain, especially in cancer patients, often sets problems to patient and therapist. While epidural and intrathecal spinal administration of opiates is a routine treatment in pain with a sub-diaphragmatic topography it is almost ineffective in cervicocephalic or thoracic cancer. An alternative here is the administration of morphine into the lateral or third ventricle by a catheter-reservoir system. ⋯ Analgesia takes effect within a few minutes and the necessary doses are low. Our results agree with those of other authors describing good to excellent results in 95% of patients with somatogenic pain. However, no or only minimal effect is achieved in the treatment of neurogenic pain by intracerebroventricular morphine therapy.