Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Nov 1985
Clinical Trial[Adjuvant chemotherapy in breast cancer. Report and commentary on the NIH Consensus Development Conference, Bethesda, Maryland, U.S. 9-11 September, 1985].
Adjuvant chemo- and endocrine treatment in breast cancer are effective treatment modalities. However, the cure rate in this disease is still not satisfying. Using prospective clinical trials further treatment procedures should be evaluated. ⋯ Postmenopausal patients with axillary node metastases and receptor-positive tumours should be treated with tamoxifen. In those with positive nodes and negative receptors chemotherapy may be considered. There is no indication for routine adjuvant chemotherapy in postmenopausal patients with negative nodes regardless of hormone receptor levels.
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Wien. Klin. Wochenschr. · Jun 1985
[Letters of discharge from a University Department of Medicine. Attempt at an analysis of their contents].
498 discharge letters, written by physicians at the Second Department of Medicine, University of Vienna were subjected to the following content analysis: procedures employed to reach a diagnostic result, length and preferred content of letters, delay between discharge of patient and posting of letter and relationship between pragmatic versus knowledge-oriented concepts. Routine hospital diagnostic procedures achieved a marked increase in accuracy in terms of medical diagnosis over initial admittance diagnosis. ⋯ Letters addressed to general practitioners were longer and contained more assessment of the patient's condition than letters to specialists. Letters on average left the hospital 30 days after the patient's discharge.
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Patients who are Jehovah's Witnesses present a special problem when undergoing open heart surgery since they refuse blood transfusion. We performed 15 open heart operations for both acquired and congenital heart disease using a modified version of isovolaemic haemodilution and bloodless prime technique of extracorporeal circulation. ⋯ One death might have been at least indirectly related to the regimen which excludes blood substitution. We believe that our experience demonstrates the feasibility of open heart procedures in Jehovah's Witnesses, although the mortality risk is increased in these patients.
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Although the anaesthetizing effect of cocaine had been known for a long time, it was only in 1884 that Karl Koller first carried out animal experiments, followed by clinical testing in humans of the anaesthetic effect of cocaine on the eye. Freud had shortly before directed the attention of Viennese doctors to the alkaloid cocaine in a paper. Upon Freud's suggestion Königstein tested the effect of cocaine therapeutically, whilst Koller independently conceived the use of cocaine as a local anaesthetic for eye operations. Jelinek introduced cocaine into laryngology and Wölfler into surgery, as further applications for the use of this local anaesthetic.
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Wien. Klin. Wochenschr. · Mar 1985
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study on the effect of diet, exercise and iodine balneotherapy on blood rheologic parameters in diabetics within the scope of a 4 week health resort stay in Bad Hall].
A total of 123 spa patients with inadequately controlled diabetes mellitus was divided into the following 3 therapeutic groups: 1. therapeutic exercise alone, 2. iodine therapy with iodine brine (including drinking cure with "iodine-brine concentrate"), 3. remedial exercise plus iodine brine therapy. All patients received a rigidly controlled diabetic diet. The following parameters were determined at the beginning and at the end of the cure: whole blood and plasma viscosity, fibrinogen, blood glucose, total and HDL-cholesterol, triglycerides, HbA1c, alpha 2-macroglobulin, total protein, microhaematocrit. ⋯ The largest decreases were shown by blood viscosity, relative viscosity, triglycerides, cholesterol and HbA1c in group III, and by plasma viscosity in group II. alpha 2-Macroglobulins did not change. Fibrinogen was raised in groups I and III. The importance of the improved blood rheological properties is discussed, particularly with respect to reduced erythrocyte flexibility in diabetics.