Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1993
[Value of surgery in treatment of complicated gastroduodenal ulcer].
The surgical procedure in acute complications of gastroduodenal ulcers is examined with regard to risk factors and mortality. Emergency admissions to an Austrian district hospital between 1. 1. 1984 and 31. 8. 1992 for peptic ulcer are retrospectively analyzed. 293 patients were admitted with a history of bleeding ulcers. Endoscopic haemostasis was achieved in 91 of 130 (70%) patients with active haemorrhage (Forrest Ia, Ib). ⋯ Postoperative mortality was 9.1% (5/55) for bleeding peptic ulcers and 6.1% (2/33) for perforated ulcers. Furthermore, mortality was zero in patients younger than 60 years (0/44), but 15.9% (7/44) in patients older than 60 years. Distal gastric resection was chosen as standard procedure for emergency operations.
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Better understanding of respiratory physiology and progress in ventilator technology have contributed to improved mortality and morbidity of premature neonates. Yet, pulmonary complications remain high and there is no consensus about the optimal regimen of mechanical ventilation. ⋯ However, our own results and the results from most surfactant studies show no significant reduction in the incidence of intraventricular haemorrhage. Thus, though mechanical ventilation and surfactant administration are milestones in neonatal therapeutic management, the problems encountered in very low birth weight neonates both with respect to mortality and morbidity have not been generally solved and underline the role of optimal perinatal management.
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Wien. Klin. Wochenschr. · Jan 1993
[Tension headache--new evaluation of symptomatology based on International Headache Society diagnostic criteria].
This study presents the history and clinical findings in 80 patients suffering from tension-type headache diagnosed according to the criteria (group 2) proposed in 1988 by the Headache Classification Committee of the International Headache Society (IHS). The aim of this investigation was to evaluate the extent to which the symptomatology in our cases still corresponds with the clinical picture of tension headache described in the older literature. A positive family history of headache was obtained in 59% of the patients; mothers of headache patients were affected five times more often than fathers; a history of migraine was reported as frequently as tension-type headache in the families of the investigated patients. ⋯ Oral contraceptives influenced neither frequency nor intensity of headache attacks. Signs of depressive disorders were present in 28% of the female patients. The differences in symptomatology of tension-type headache between patients with episodic and chronic forms, between female and male patients, and also between younger and elderly patients are documented and have to be taken into account in the diagnostik evaluation of this condition.
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Wien. Klin. Wochenschr. · Jan 1993
Case Reports[Pain syndromes of the tibial nerve at the leg-foot transition].
The prognosis of surgical treatment of the tarsal tunnel syndrome (TTS) with regard to total pain relief is worse than following surgery of the carpal tunnel syndrome. In TTS, additional static factors play a role. The indication for surgery, therefore, is made with utmost reluctance. ⋯ Three such patients are reported. This pain syndrome is caused and increased by recurrent fibrosis of the nerve bed, eventually including the integument and inducing entrapment neuropathy by the contracted dermal covering. Surgical resolution of this problem is transplantation of soft tissues to surround the nerve and skin grafting to augment the covering dermal layer.
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Wien. Klin. Wochenschr. · Jan 1993
[Prospective study of determining the value of D-dimer in diagnosing pulmonary embolism].
Pulmonary embolism (PE) is still misdiagnosed in a high proportion of cases. 107 patients admitted for suspected pulmonary embolism were studied prospectively to shed light on the value of ELISA-D-dimer and Latex-D-dimer. Pulmonary embolism was ruled out by negative perfusion scans in 66 patients (61.7%) and by angiography in 24 patients. 58% of the scans suggesting a high probability of PE were confirmed by angiography, but only 18% of the scans suggesting a low or intermediate probability of PE. ⋯ The positive predictive value was improved by ELISA-D-dimer in both groups to 75%. In order to augment the diagnostic efficacy in clinical practice the determination of Latex-D-dimer simultaneously with lung scanning is recommended.