Wiener medizinische Wochenschrift
-
Wien Med Wochenschr · Jan 2007
Review[Invasive candidiasis in the critically ill, patient non-neutropenic].
Invasive candidiasis can occur in immunosuppressed patients as well as in critically ill, non-immunocompromised patients and is associated with high mortality (20-40 %). Intestinal Candida colonisation is an important source for invasive candidiasis. ⋯ Among patients with invasive candidiasis, antifungal treatment should be started without delay. Antifungal prophylaxis is currently not recommended in critically ill, non-immunocompromised patients.
-
Invasive fungal infections (IFI) are a major cause of morbidity and mortality in cancer patients receiving myelotoxic chemotherapy. Established risk factors are previous fungal infection, neutropenia exceeding 10 days, older age, active cancer, corticosteroid therapy, administration of broad spectrum antibiotics, allogeneic HSCT, central venous catheter and organ dysfunction. The strategies to manage IFI comprise chemoprophylaxis, preemptive, empirical and directed antifungal therapy. ⋯ Liposomal amphotericin B is a good alternative candidate and caspofungin is reserved for salvage treatment. Invasive candidiasis should be treated with caspofungin or one of the lipid based amphotericin B formulations. Since non-albicans species are increasingly observed, the use of fluconazole is reserved for "stable", non-neutropenic patients.
-
Fibromyalgia is a common chronic pain syndrome affecting particularly middle aged women. The symptomatology is characterized by diffuse widespread myofascial pain and tenderness on palpation at multiple "tender points". Additional symptoms are various vegetative and functional disorders, nonrestorative sleep, depression and anxiety. ⋯ Medication and physical therapies only accomplish some temporary symptomatic relief (30-50%). Psychosomatic rehabilitation should not focus on reduction of pain, but rather on physical reconditioning and development of an active coping style. In this context psychological interventions, education and psychotherapy are essential.
-
The expectations of total joint replacement are constantly increasing: Freedom of pain and mobility used to be the primary goal, while nowadays it is longevity despite heavy loading and intense sporting activity. A preoperative sportive patient expects to be able to perform his favorite sporting activities like hiking, swimming and cycling, but also the more demanding skiing, tennis and jogging, for example, after surgery. The aim of this article is to illustrate what level of sporting activities can be performed by patients with total joint replacement. Are there differences between the pre- and postoperative levels? What are the risks for, and negative influences on, the prosthesis during intense sporting activity? What is the role of the physician? Finally, recommendations for sporting activities after total hip and knee replacement are given.
-
Wien Med Wochenschr · Jan 2007
Bacterial contamination of solutions for parenteral administration for single- and multiple-dose vials after multiple use in the hospital.
Outbreaks traced to bacterial contamination of multiple-dose vials are reported in the literature. During a four-month period, multi-dose vials (MDVs), single-dose vials (SDVs), and vials containing self-prepared admixtures were collected from various wards to analyse sterility of their contents. We examined 68 commercially available MDVs containing sodium chloride 0.9% or heparin with added preservative and 17 single dose vials (SDVs) containing aqua ad injectionem or sodium chloride 0.9% and 11 vials with admixtures (ADX) of heparin and sodium chloride 0.9%, both without preservative. ⋯ On average, the volume of the samples was 80% of the original volume. A proportion of 4% of vials was not sterile. A training programme for health care workers in aseptic techniques and for validation of the preparation of solutions for parenteral use should be installed.