Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 1999
Review[Clinical value of electroconvulsive therapy in treatment of depression].
The electroconvulsive therapy (ECT), which provokes a generalized epileptic seizure by an electrical stimulus, was first administered in 1938 and performed without anesthesia during thirty years. Nowadays, ECT is carried out using brief anesthesia (preferably methohexital) and skeletal muscle relaxation (succinylcholine) to avoid fearful complications like bone and muscle fractures. ECT is a safe treatment without absolute contraindications; the treatment risk corresponds to the risk of general anesthesia. ⋯ Brief pulse stimulation, unilateral nondominant electrode placement and individual stimulus titration with respect to seizure threshold (EEG monitoring is required!) can minimize cognitive side effects. The apprehension that ECT could cause prolonged amnesia and structural brain damage has not been confirmed by the available scientific data. Modern brain imaging methods could elicit the until now unknown mode of action of ECT.
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The term "decompression illness (DCI)" is a disorder which arises from the presence of ectopic gas bubbles following decompression. Scuba diving poses the risk of two typically clinical syndromes: decompression sickness (DCS) and arterial gas embolism (AGE). DCS results from the formation of gas bubbles in the tissues of the body and in the blood due to rapid reduction of the environmental pressure. ⋯ Although the pathophysiological mechanisms of these two disorders are quite different, both of them lead to the same result: inert gas bubbles that may cause impairment of vital functions due to hypoxia. Recognizing the signs and symptoms of DCI is the first step of the therapy. The emergency treatment contains: basic life support, advanced life support--if necessary, horizontal positioning of the victim, administration of 100% normobaric oxygen via face mask or endotracheal tube, rehydration, rapid transportation to the nearest emergency department/hyperbaric facility for definitive treatment in order to prevent serious neurological sequelae.
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Wien Med Wochenschr · Jan 1999
[When should a patient with severe acute respiratory distress syndrome (ARDS) be transferred to a specialized hospital?].
The mortality rate for the advanced adult respiratory distress syndrome is still high. Nevertheless there are recent publications showing decreasing incidence and an improving survival rate. This is due to early diagnosis as well as differentiated treatment concepts. ⋯ The mortality rate was 22.3% altogether, in the group with the conventional treatment 16.0% and 32.6% in the group with ELA. As there are no generally accepted guidelines for the transfer of patients with ARDS to specialized centres, an indication for such a transfer must be established taking into consideration the individual patient history. Very early contact with the specialized centre of choice is recommended.
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Recent lipid intervention studies led to the implementation of lipid lowering therapy in the cardiovascular risk management. These secondary as well as primary prevention studies share the effect of HMG-CoA-reductase inhibition. Despite varying product properties there seem to be no major differences in risk reduction between the drugs. ⋯ One could be surprised that the "intervention group" was not better, though representing the usual clinical procedere. Interestingly, borderline significant (p < 0.046 at a level of significance of p < 0.045), results were in favor for the drug treated group. Such data could, if confirmed in further investigations, change cardiovascular disease management to aggressive lipid lowering prior to or instead invasive management, especially in initial therapy of CVD and diabetes mellitus type II.
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Wien Med Wochenschr · Jan 1999
[Current status of therapy of lymphedema in Austrian hospitals--a comprehensive Austrian survey].
The overall Austrian survey of the Austrian Lymph-Liga on the acutal state of the diagnosis and therapy of the hospitals of Austria is represented by making enquiries in 178 hospitals. The response was moderate at 34%, with only 46 hospitals offering a therapy of lymphedemas (approximately 26%). The type of therapy does not seem standardized at the Austrian hospitals. ⋯ Supplementary data of a "Quality of life" survey among lymphedema patients underline the necessity of a concept for standards, diagnosis and therapy. More than half of the patients asked (65%) complained about a time period of 5 to 10 years from the beginning of the illness till the beginning of a definitive therapy. Every other patient does not feel optimally treated and is under an increased pressure of suffering.