Wiener klinische Wochenschrift
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In spontaneous breathing intrathoracic pressure alternates between positive and negative in a biphasic sequential pattern. By contrast, during mechanical ventilation (IPPV, CPPV) the intrathoracic pressure remains above atmospheric all the time. ⋯ In order to minimize these deleterious effects of positive pressure ventilation it is essential to keep the procedure as short and little invasive as possible. The following strategy enables this goal to be brought closer: 1) early commencement of ventilation; 2) optimal adjustment of artificial ventilation to the individual needs of the patient, 3) early weaning from assisted ventilation through augmented rather than controlled modes of ventilation: 4) kinetic therapy (systematic changing of the patient's position) with the back up of the requisite thoracic CT scan findings; 5) reduction of the invasiveness of the procedure in order to ensure early commencement of spontaneous respiration.
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Seasonal changes in human behavior have been recognized since ancient times. Starting in 1980 systematic research has been carried out by Rosenthal et al. (1984), who described and characterized a psychopathological and clinical syndrome which is linked to fall/winter and shows remission in spring/summer and which was termed seasonal affective disorder (SAD). ⋯ The efficacy of light therapy with bright, fluorescent, full-spectrum light has been widely demonstrated for treatment of fall/winter SAD. In addition, treatment with selective serotonin reuptake inhibitors appears to be successful in this condition.
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Wien. Klin. Wochenschr. · Jan 1994
Review[The value of metformin in therapy of type 2 diabetes: effect on insulin resistance, diabetic control and cardiovascular risk factors].
In this review article recently published controlled clinical studies of metformin treatment in type-2 diabetic patients are summarized. Several studies demonstrate that body weight decreases and insulin resistance improves--as evaluated by peripheral glucose utilisation--under metformin treatment. HbA1c is lowered by approximately 20% (absolute decrease of HbA1c: 1.0%-1.5%). Since plasma lipid values and plasminogen-activator-inhibitor (PAI-1) concentrations are also lowered under metformin therapy, it currently represents the treatment of choice for the obese group of type-2 diabetic patients.
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Wien. Klin. Wochenschr. · Jan 1994
Case Reports[Miliary tuberculosis of the liver as a cause of septic shock with multi-organ failure].
A woman aged 63 presented with septic fever, followed by hepatocellular jaundice. Viral hepatitis was ruled out by serologic tests, but no definite diagnosis could be made. ⋯ In spite of intensive care measures, the patient died of disseminated intravascular coagulation and multiorgan failure caused by septic shock. The correct diagnosis of miliary tuberculosis was made only post mortem by histopathological examination of liver specimens and confirmed by detection of Mycobacterium tuberculosis DNA in the patient's liver by polymerase chain reaction.
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Wien. Klin. Wochenschr. · Jan 1994
Case Reports[Myoglobinuria and carnitine palmitoyltransferase deficiency. Diagnostic procedure and differential diagnosis].
Carnitine palmitoyltransferase (CPT) deficiency is the most common metabolic cause of recurrent myoglobinuria. We describe five patients with CPT deficiency who were recruited during a 24-months period. ⋯ The diagnostic procedure includes a neurological and electromyographical examination as well as an exercise test and extensive biochemical investigations of muscle biopsy specimens. Accurate diagnosis allows an early introduction of preventive measures and clearly improves the outcome.