Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe management of pneumothorax with the thoracic vent versus conventional intercostal tube drainage.
The thoracic vent is a new minimally invasive device for the treatment of spontaneous and iatrogenic pneumothorax. It consists of a polyurethane catheter connected to a plastic chamber containing a one-way valve. As there is no need to connect the thoracic vent to an underwater seal device, immobilization and hospitalization can be avoided. ⋯ Hence, we have performed a randomized study comparing the treatment of pneumothorax by means of the thoracic vent versus conventional intercostal tube drainage in 30 patients, including some with tension pneumothorax. 17 patients were treated with the thoracic vent, 13 with conventional intercostal tube drainage. We found no significant differences in the rate of reexpansion and rate of complications between the group treated with the thoracic vent and the group treated with intercostal tube drainage, but the patients treated with the thoracic vent needed significantly less analgesics. 70% of the patients treated with the thoracic vent were successfully managed on an outpatient basis. All patients treated with intercostal tube drainage were hospitalised; duration of inpatient-therapy was 8 +/- 6.2 days (mean +/- SD).
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Wien. Klin. Wochenschr. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialSafety and efficacy of increasing dosages of glycyl-glutamine for total parenteral nutrition in polytrauma patients.
Supplementation of parenteral nutrition with glutamine (GLN) has been suggested to improve the efficacy of nutritional support by stimulating protein synthesis and improving immunocompetence. In the present study we investigated the impact of infusing the dipeptide glycyl-glutamine (GLY-GLN) at increasing dosages on plasma amino acid concentrations in patients with polytrauma. Nine polytraumatized patients were randomly assigned according their age and their trauma score to three experimental groups. ⋯ We conclude from this first available dose finding study on glutamine-containing dipeptides that in polytraumatized patients infusion of 570 mg/kg/day of GLY-GLN (corresponding to 28 g glutamine or 40 g dipeptide/70 kg, respectively) is necessary to induce a sustained effect on plasma glutamine concentrations. No pathological accumulation of free glycine or of the dipeptide was seen with any of the three dosage steps of GLY-GLN. Thus, the administration of even high doses of GLY-GLN is feasible and safe in patients with polytrauma and is not associated with any relevant renal substrate loss.
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Wien. Klin. Wochenschr. · Jan 1996
Review Comparative Study[Current treatment strategy in malignant pleural effusion].
Malignant pleural effusions are a grave consequence of advanced cancer disease. The successful suppression of pleural fluid reaccumulation can make a major contribution to the management and palliative care of patients with disseminated cancer. Many treatment concepts have been reported in the literature. ⋯ Talc was superior to other agents in 6 of 6, Corynebacterium parvum in 3 of 4 and bleomycin or tetracycline only in 3 of 8 studies. Adverse effects were frequently observed with cytostatic agents, but were very rare in the case of talc or fibrin instillation. Comparing the recently published data pleurodesis with talc appears to be the most effective treatment strategy, followed by Corynebacterium parvum, bleomycin and tetracycline.
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Wien. Klin. Wochenschr. · Jan 1996
Review[The value of adjuvant and neoadjuvant chemotherapy in treatment of stomach carcinoma].
The incidence of gastric adenocarcinoma has decreased dramatically in most Western countries over the past five decades. However, the five-year survival rate remains poor and late diagnosis is one of the main reasons for the lack of marked improvement in outcome. More than 50% of the patients found to have advanced local (stage T III), or systemic (stage T IV) gastric cancer at the time of diagnosis. ⋯ The efficacy of neoadjuvant chemotherapy in potentially resectable gastric carcinoma cannot be definitely assessed at the present time since only scant, preliminary findings are available. Future goals for the treatment of gastric carcinoma should include studies evaluating preoperative chemotherapy using effective, but less toxic substances, based on exact tumor-staging by means of endoluminal sonography. Furthermore, research projects investigating the value of intraperitoneal therapeutic regimens such as hyperthermic chemoperfusion or intraperitoneal instillation of the requisite substances in the prevention of intraperitoneal carcinomatosis and local recurrence will be of great importance.