Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 2001
Review Comparative Study[Therapy of invasive organ mycoses in patients with systemic hematologic diseases].
Fungal infections have increased substantially in patients with acute leukemia as well as in patients receiving allogeneic stem cell transplantations. Most frequently Aspergillus ssp. and Candida ssp. are observed. Despite the recent introduction of new azoles and lipid-based formulations of amphotericin B, there are few randomized, controlled studies on the use of antifungal drugs in patients with proven invasive fungal infections. ⋯ An additional serious problem is an emerging resistance of non-albicans species to fluconazole. Lipid-formulations of amphotericin B seem to be attractive alternative, but considerably higher medical costs limit broader application of lipid formulations of amphotericin B. The current strategies for the treatment of documented fungal infections as well as the role of new antifungal agents are discussed in this review.
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Hallucinations are perceptions lacking any extern or physical stimulus. They can affect all senses and may occur in the course of different physical or psychiatric diseases. ⋯ It is important not only to diagnose the basic disorder or illness but also to deal with the patient's anxiety, respect his/her perceptions and to try to establish alternative models of explanation. Apart from therapy of the underlying disorder it is wise to recommend psychotherapy and the attendance of self-help groups.
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An acute abdomen may result from various diseases, with appendicitis, cholecystitis, pancreatitis, and obstruction of the small and the large bowel as the leading causes. The quality of diagnostic imaging has been improved within the last years especially by recent developments of cross-sectional imaging modalities. Sonography is an efficient modality for detecting cholecystitis and appendicitis. Spiral computed tomography is the modality of choice in case of suspected bowel obstruction or pancreatitis.
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Wien Med Wochenschr · Jan 2001
Review[Angiotensin II type-1 receptor antagonists and diabetes mellitus].
Arterial hypertension is a major risk factor for microangiopathic diabetic complications and associated with an increased cardiovascular morbidity and mortality. An intensified antihypertensive treatment reduces microangiopathic complications and cardiovascular morbidity and mortality in diabetic patients. Even in normotensive type 1 and type 2 diabetic patients, the treatment with ACE inhibitors may prevent the later development of diabetic nephropathy. ⋯ Further, it is unknown whether different phenotypes of the ACE gene (DD, II polymorphism) require different therapeutic options. In conclusion, treatment with angiotensin II receptor antagonists is well-tolerated and has no adverse effects on metabolic control in diabetic patients. The beneficial effect on microangiopathic complications however has to be proven in randomized long-term studies in direct comparison with ACE inhibitors, which were clearly shown to delay the development and progression of diabetic nephropathy.
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Fractures of the distal radius are common counting for 17 percent of all fractures. With conventional radiography they can be classified readily. Magnetic resonance imaging (MRI) is a suitable technique for the detection of occult forms of fractures and of associated soft tissue injuries. ⋯ Indications for arthrography are injuries of the ligaments or of the joint capsule. Fractures and dislocations of the metacarpal, and the phalangeal bones are the most common fractures of the skeletal system. Conventional radiography is the primary imaging technique, followed by sonography and MRI to detect injuries of the ligaments and tendons.